Dimethyl Fumarate
Specialty Drug


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Dimethyl Fumarate Medicare Coverage


Does Medicare cover Tecfidera?

72% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Tecfidera co-pay with Medicare?

It depends. Which coverage stage are you in? Click on a tab below…

Donut Hole
Post-Donut Hole
Co-Pay Range
$5648 – $7262
In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.
Co-Pay Range
$1412 – $7262
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$2459 – $7262
In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year.
Co-Pay Range
$15 – $7262
In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare will cover most of your drug costs. In 2016, this stage begins once you have spent $4,850.
Want an exact price for your co-pay?

Ways to Save on Dimethyl Fumarate

Here are some ways that may lower the cost of your Tecfidera prescription.

Manufacturer Assistance Program
Call to get more information on how they can financially assist you with your prescription.
Manufacturer Assistance Program
Call to get more information on how they can financially assist you with your prescription.

Find Your Dimethyl Fumarate Medicare Co-Pay

Here are average co-pays for some of the most popular Medicare plans. Be sure to add your plan to see your specific co-pay. If a price is shown in red, GoodRx has found discount prices that are lower than your Medicare co-pay.

Average Co-Pay for 1 dose pack (60 capsules) of Tecfidera 240mg

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $1689
AARP MedicareComplete Plan 1 (HMO) $1765
AARP MedicareComplete SecureHorizons (HMO) $1629
AARP MedicareRx Preferred (PDP) $1958
AARP MedicareRx Saver Plus (PDP) $1529
Aetna Medicare Rx Saver (PDP)Lower price available $7262
Cigna-HealthSpring Preferred (HMO)Lower price available $7262
Cigna-HealthSpring Rx Secure (PDP)Lower price available $7262
Cigna-HealthSpring Rx Secure-Extra (PDP)Lower price available $7262
EnvisionRxPlus Silver (PDP) $1524
Express Scripts Medicare - Value (PDP) $1536
First Health Part D Value Plus (PDP)Lower price available $7262
Humana Enhanced (PDP) $2010
Humana Preferred Rx Plan (PDP)Lower price available $7262
Humana Walmart Rx Plan (PDP)Lower price available $7262
Kaiser Permanente Senior Advantage (HMO) $2034
MedicareBlue Rx Standard (PDP)Lower price available $7262
SilverScript Choice (PDP)Lower price available $7262
Symphonix Value Rx (PDP) $1524
WellCare Classic (PDP)Lower price available $7262
Don't see your Medicare plan above?

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Dimethyl Fumarate Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Tecfidera that may include:

Quantity Limits

Most Medicare plans restrict the amount of this prescription that can be purchased at one time. If you need to purchase a greater amount at one time, it may not be covered. Your options are to wait until that time period has passed before refilling, call your plan and ask for an exception, or consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

Prior Authorization

Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan and they may require you to have your doctor fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

What drug tier is Tecfidera typically on?

Tier 5

Medicare plans typically list Tecfidera in Tier 5 of their formulary. Tier 5 drugs are usually non-preferred brand-name drugs. Tier 5 drugs cost more than Tier 1, 2, 3 and 4 drugs.

Does your plan have restrictions?

See discount prices that can save you money when your Medicare plan doesn't work for you.

Medicare prices are provided by the Centers for Medicare and Medicaid Services (CMS). If you encounter any issues, please let us know.
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