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Does Medicare Cover Cosentyx?

Does Medicare Cover Cosentyx?

Cosentyx is a prescription medicine used to treat moderate to severe plaque psoriasis, psoriatic arthritis, and spinal arthritis (ankylosing spondylitis, non-radiographic axial spondyloarthritis, and enthesitis).

Cosentyx’s main ingredient, Secukinumab, is a monoclonal antibody that blocks a molecule that causes swelling and pain, reducing and eliminating psoriasis or arthritic symptoms.

If this medication can help you or a loved one, a common question many have is, “Does Medicare cover Cosentyx?” In this article, we answer the question in clear, plain English. You will also find the average costs of Cosentyx and other helpful info.

Does Medicare Cover Cosentyx?

The short answer is no. In most cases, Original Medicare will not cover the cost of Cosentyx. However, some Part C and D plans do cover this drug. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Cosentyx. 

Medicare Part A and B

Original Medicare (Medicare Part A and Part B) does not provide coverage for Cosentyx. That is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or Medicare Part D.  

Medicare Part C and D

Some Medicare Advantage plans (Medicare Part C) provide coverage for Cosentyx. Medicare Advantage plans cover everything Original Medicare covers but will offer additional benefits Original Medicare does not.

However, what each Part C plan covers and how much the out-of-pocket costs are will depend on your plan.

Part C plans that include prescription drug plans will also provide coverage for many medications your healthcare provider will prescribe. When it comes to Cosentyx, not all Part C prescription plans provide coverage for the drug.

Some Medicare Part D plans also provide coverage for Cosentyx. Medicare Part D is a prescription drug plan. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

Currently, around fifty-five percent of both Medicare Part C and Part D plans provide coverage for the medication Cosentyx. 

Cosentyx is listed as a tier 5 drug in the Medicare drug formulary. Most of the time, the Medicare drug formulary only has five tiers. Tier 5 medications are more expensive than Tier 1, 2, 3, and 4 medications.

Most Medicare plans may also require prior authorization before providing coverage for this medication. The usage of this medication has to be for medically necessary purposes. You must contact your plan provider to get authorization. 

How Much Does Cosentyx Cost?

The average cost of a 150 mg or 300 mg dose of Cosentyx is almost $6,700 per injection.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series, including: Does Medicare Cover Aortic Aneurysm Surgery?

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