Does Medicare Cover Fasenra?

Eosinophils are part of the body’s immune system that fight infections and invading bacteria. However, for people with Eosinophilic asthma, these white blood cells can cause inflammation and swell in a person’s airways and respiratory systems. One medication meant to treat this condition is called Fasenra.

So, for people facing this condition, a common question they have is, “does Medicare cover Fasenra?” In this article, we answer that question in clear, plain English. You will also find the average costs of Fasenra and other helpful info.

The short answer is yes; Medicare will cover the cost of Fansera. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Fansera. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for Fasenra. Parts A and B mainly cover medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or by Medicare Part D.

However, Medicare Part B provides coverage for Fansera if the doctor administers the medication in an outpatient setting. Medicare Part B covers 80 percent of the costs of your Fansera. You will pay for the remaining 20 percent.

Part C and Part D Coverage for Fasenra

Medicare Advantage plans (Medicare Part C) also provide coverage for Fansera. Advantage plans must cover everything that Original Medicare covers. But they will cover a number of other things as well. What each plan covers and what the costs are to you will vary depending on the plan you get.

Medicare Part D plans also provide coverage for Fasenra. However, only about a third of Medicare Part C and Part D plans provide coverage for this drug.

Fasenra is listed as a Tier 5 drug in the Medicare drug formulary. Tier 5 medications are more expensive than Tier 1, 2, 3, and 4 medications.

Most Medicare plans also may require you to have prior authorization before they provide 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 Fasenra Cost?

A supply of 1 milliliter of 30 mg/mL of Fasenra can cost $5,200. However, the price may differ depending on which pharmacy you purchase the drug from.

What Is Fasenra?

Fasenra is a medication used to treat asthma and it can be used along with other medications for asthma. It is only for people who are ages 12 and above with asthma that cannot be controlled by their current asthma medications. This medication helps in preventing severe asthma attacks and may as well improve the user’s breathing.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. 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.