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How much should I expect to pay for Cimzia® (certolizumab pegol)?

 

Prescription drug prices can be confusing. Two people may pay different prices for the same drug, depending on their insurance situation.

The list price1 of CIMZIA is $5,099.682 per two prefilled syringes, but the amount you pay will largely depend on your prescription drug insurance plan. The information below will give you a good idea of what to expect based on your insurance situation.

For the most accurate information, talk to your insurance provider who knows the details of your plan.

 

Full Prescribing Information, including boxed warning regarding serious infections, including tuberculosis, and certain malignancies.

 

Which Option Below Best Describes Your Insurance Situation?

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I Have Insurance Through an Employer or Private Individual Policy and Am Not Covered by Medicare

 

About 61% of CIMZIA prescriptions cost patients between $0-$200 per month; for the remaining 39% of prescriptions, the most common cost is $250 per month.3

What you pay for CIMZIA will depend on your insurance plan. Each plan has different preferred drug lists and out-of-pocket amounts, and most include an annual deductible. If you haven’t met your deductible, you’ll see higher prices until the deductible is met; then your out-of-pocket cost will likely drop. With the CIMZIA Savings Card, a one-month supply of CIMZIA can cost as little as $0. Learn more about the CIMZIA Savings Card.

I Have Medicare Coverage

If you have Part D coverage and are eligible for the Extra Help4 program, you can expect to pay $3.70 - $9.20 for each prescription.5

If you are unsure whether you qualify for Extra Help, please visit the Social Security Administration for more information.

If you don’t qualify for Extra Help, your out-of-pocket costs vary. About 75% of CIMZIA prescriptions cost patients between $0 and $200 a month, and the remaining 25% cost an average of $700 a month.6  Your out-of-pocket costs can vary throughout the year depending on which phase of the Part D benefit you are currently in.7  If you have coverage through traditional Medicare Part B, after you satisfy your deductible, Medicare covers 80% of the drug cost, and you  pay the remaining 20% coinsurance. Supplemental Medicare insurance plans may also cover this 20% depending on your plan.8 This may vary from year to year. If you have Medicare Advantage coverage, what you pay for CIMZIA will depend on your insurance plan. Each plan has different preferred drug lists and out-of-pocket amounts, and most include an annual deductible. If you haven’t met your deductible, you’ll see higher prices until the deductible is met; then your out-of-pocket cost will likely drop.11 

I Have Medicaid Coverage

For most people on Medicaid, prescription drugs like CIMZIA range from $4.90-$9.80 per month.9 Some states offer even lower copays, or eliminate the copay requirement altogether.

To find out if you qualify for Medicaid, or for more information about copayments in your state, please visit Medicaid's website
 

I Don’t Have Insurance or CIMZIA Is Not Covered By My Insurance Plan

 

If you do not have insurance or CIMZIA is not covered by your insurance plan, please contact our team of compassionate and informed professionals for more information to see what options might be available to you. Contact ucbCARES at 1-844-599-CARE (2273) or visit us online.

1 List price is also referred to as wholesale acquisition cost or WAC. WAC is the price at which UCB sells its products to wholesalers. A monthly supply of CIMZIA is defined as 2x200mg/mL prefilled syringes per 4 weeks. List price for the LYO formulation is the same. 

2 AnalySource. Accessed on January 1, 2022. Patients may have to pay a higher price than list due to additional pharmacy charges. Based on CIMIZIA 2x200mg/mL.

3 IQVIA LAAD data, CIMZIA, Commercial, OPC Before Buydown, Paid + Reversed Claims, New Patients, Final & Standalone Claims (Jul 2020-Jun 2022).  Accessed on January 13, 2022.

4 Social Security Administration (SSA). Extra Help with Medicare Prescription Drug Plan Costs. https://www.ssa.gov/benefits/medicare/prescriptionhelp. Accessed January 2019.

5 IQVIA LAAD claims data (Jul 2020-Jun 2021) and Centers for Medicare & Medicaid Services (CMS). Announcement of Calendar Year (CY) 2022 Medicare Advantage(MA) Capitation Rates and Part C and Part D Payment Policies (cms.gov). https://www.cms.gov/files/document/2022-announcement.pdf . Accessed on January 12, 2022.

6 IQVIA LAAD data, CIMZIA, Medicare Part D, OPC Before Buydown, Paid + Reversed Claims, Final & Standalone Claims (Jul 2020-Jun 2022).  Accessed on December 12, 2022. 

7 Drug coverage under Medicare Part D is divided into four phases: 1) deductible, 2) initial coverage, 3) coverage gap, and 4) catastrophic. Each of these phases has different cost sharing amounts.

8 Medicare.gov Prescription drugs (outpatient) - https://www.medicare.gov/coverage/prescription-drugs-outpatient. Accessed on January 13, 2022.

9 IQVIA LAAD data (Jul 2020-Jun 2022) and Centers for Medicare & Medicaid Services (CMS). Medicaid and CHIP Overview. Maximum Allowable Copayments Determined by Eligible Population’s Household Income. Updated October 2021. **All out-of-pocket charges are based on the specific state’s defined payment amount for that service. Certain groups, including children, terminally ill individuals, and individuals residing in an institution are exempt from cost sharing. Refer to your state agency for details about Medicaid out-of-pocket costs. https://marketplace.cms.gov/technical-assistance-resources/medicaid-chip-overview.pdf. Accessed January 2022.

10 Most consumers have some type of health insurance coverage that includes a prescription drug benefit. According to recent data, just under 9% of the total U.S. population is uninsured. (https://www.kff.org/state-category/health-coverage-uninsured/health-insurance-status).

11 Drug coverage under different parts of Medicare (https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/11315-P.pdf). Accessed Jan 10, 2022.