How Much Should I Expect to Pay for RYSTIGGO® (rozanolixizumab-noli)?
Prescription drug prices can be confusing. Two people may pay different prices for the same drug, depending on their health plan situation.
The list price1 of RYSTIGGO is $6,050 per vial,2 but the amount you pay will largely depending on your health plan coverage. The number of RYSTIGGO vials administered by your healthcare provider is determined by your weight and is given in cycles only when needed based on your provider's assessment of your symptoms. The information below will give you a good idea of what to expect, based on your health plan.
For the most accurate information, talk to your health plan or health plan provider, as they know the details of your plan.
Which Option Below Best Describes Your Health Plan Situation?
I Have a Health Plan Through an Employer or Private Individual Policy
What you pay for RYSTIGGO will depend on your health plan.3 Each plan has different preferred drug lists, preferred sites of care, 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.
I Have Medicare Coverage
If you have traditional Medicare4 Fee For Service Part B and a Medigap plan you could pay $0 per month after you meet your deductible.5
If you have enrolled in a Medicare Advantage Plan your costs will vary from $0 to the plans out-of-pocket max. The maximum out-of-pocket limits on Medicare Advantage plans vary. Each year the Centers for Medicare & Medicaid Services (CMS) sets an out-of-pocket max and your cost cannot exceed that amount.
Additionally, there are different limits when receiving care in-network versus out-of-network.
I Have Medicaid Coverage
For most people on Medicaid, prescription drugs like RYSTIGGO range from $4.90 - $9.80 per month.6 Some states eliminate the copay requirements altogether.
To find out if you qualify for Medicaid, or for more information about copayments in your state, please visit the Medicaid website.
I Don’t Have Insurance or RYSTIGGO Is Not Covered By My Insurance Plan (7)
For more information, please contact ONWARD at 1-844-669-2731 or visit ucbOnward.com. With ONWARD, each patient will be assessed at the individual level to understand their coverage and explain potential financial assistance options that could help.
- AnalySource powered by First Data Bank accessed on June 2023. List price is also referred to as wholesale acquisition cost or WAC. WAC is the price at which UCB sells its products to wholesalers. Rystiggo is dosed in cycles. A cycle consists of 1 subcutaneous infusion given weekly for 6 weeks. The volume of RYSTIGGO given in the infusion varies based on the patient’s weight. RYSTIGGO is available in a single use vial containing 280 mg/2 mL.
- AnalySource accessed on June 2023. AnalySource will publish a Wholesale Unit Cost and Extended Unit.
- Based on Commercial Health Plan benefit design (Kaiser Foundation 2022 Employer Health Benefits Survey -- 2022 Employer Health Benefits Survey) and the most common Tier coverage of Specialty Biologics.
- ‘Medicare Drug Finder’ to determine benefit design for each patient type. Part D cost sharing, or out of pocket (OOP) costs, can depend on eligibility for ‘Extra Help’ (Part D health plan receives a Low-Income Subsidy to manage these patients, enrollment in standard Prescription Drug Program [PDP] or have gap coverage via Medicare Advantage). Average OOP costs are determined based on patient phasing through initial Deductible, Standard OOP, Donut Hole, then catastrophic coverage. https://www.medicare.gov/plan-compare. Accessed June 2023.
- Most Medicare Supplement Insurance policies cover 100% of Part B coinsurance or copayment. Policies which do not cover 100% may cover 50%-70% of coinsurance or copayment. https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
- Centers for Medicare & Medicaid Services (CMS). Medicaid and CHIP Overview. Maximum Allowable Copayments Determined by Eligible Population’s Household Income. Updated November 2022. **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 June 2023.
- Most consumers have some type of health plan 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. Accessed June 2023.
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