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How much should I expect to pay for Nayzilam® (midazolam) nasal spray, CIV?

 

 

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 NAYZILAM is $587.952 per box. Each box contains two doses.  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.

As a new product, coverage and affordability are still being determined by many health plans. For the most accurate information, talk to your insurance provider who knows the details of your plan.

Full Prescribing Information, including boxed warning regarding concomitant use of benzodiazepines and opioids.

 

 

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 82% of NAYZILAM prescriptions cost patients between $0-$100 per box; for the remaining 18% of prescriptions, the most common cost is $125 per box.3 Each box contains two doses.

What you pay for NAYZILAM will depend on your insurance plan and which pharmacy you choose. 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 NAYZILAM Savings Card, eligible patients could pay $20 per box. Each box contains two doses. Learn more about the NAYZILAM Savings Card.

 

I Have Medicare Coverage

 

 

If you have Part D coverage and are eligible for the Extra Help (Low Income Subsidy) program, it is anticipated that you would pay less than or equal to $9.20 for each box.4 Each box contains two doses.

If you are unsure whether you qualify for Extra Help, please visit the Social Security Administration website for more information.5

If you don’t qualify for Extra Help, your out-of-pocket costs vary. About 88% of NAYZILAM prescriptions cost patients between $0 and $100 per box, and the remaining 12%, the most common cost is $145 per box.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 

I Have Medicaid Coverage

 

 

For most people on Medicaid, it is anticipated that NAYZILAM will cost less than $10 per box.8 Each box contains two doses. 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 NAYZILAM Is Not Covered By My Insurance Plan

If you do not have insurance or NAYZILAM 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.

References: 

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. For Nayzilam, WAC is for one box (containing two doses). 

2 AnalySource. Accessed on January 1, 2022. Patients may have to pay a higher price than list due to additional pharmacy charges. Based on Nayzilam 5mg/spray.

3 IQVIA LAAD data, NAYZILAM, Commercial, OPC Before Buydown, Paid + Reversed Claims, New Patients, Final & Standalone Claims (July 2020-Jun 2021).  Accessed on January 12, 2022.

4 Social Security Administration (SSA). Extra Help with Medicare Prescription Drug Plan Costs. https://www.ssa.gov/benefits/medicare/prescriptionhelp. Accessed September 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, NAYZILAM, Medicare Part D, OPC Before Buydown, Paid + Reversed Claims, New Patients, Final & Standalone Claims (July 2020-Jun 2021).  Accessed on January 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 IQVIA LAAD data (July 2020-Jun 2021) 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.

9 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).