How Much Is Cimzia Without Insurance?

Cimzia (certolizumab pegol) is an FDA-approved biologic medication used to treat autoimmune diseases, such as rheumatoid arthritis, psoriatic arthritis, and Crohn’s disease. It belongs to a class of medications called tumor necrosis factor (TNF) inhibitors. By blocking TNF (a type of protein), Cimzia helps reduce inflammation and relieve symptoms associated with these conditions.

Cimzia is given as an injection under the skin. The typical starting dose for adults is 400 mg (two 200 mg injections under the skin) at the beginning and again at weeks 2 and 4. After that, maintenance doses are usually 200 mg every other week or 400 mg every 4 weeks. Cimzia comes in 200 mg prefilled syringes for at-home use. It’s also available in vials of powder, but these require mixing and are typically used only in a healthcare setting.

Cimzia is usually distributed through specialty pharmacies, which handle medications that require extra care, such as special storage and support services. But you may be able to get it at some retail pharmacies. No generic or biosimilar version of Cimzia is available, and the medication can cost thousands of dollars. But you can reduce your costs with savings options like manufacturer programs and GoodRx coupons.

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How much does Cimzia cost?

Without insurance or discounts, a starter kit of Cimzia costs around $8925.09. This kit includes three packages, each containing two prefilled syringes with 200 mg/mL of the medication. It provides enough medication for your first three doses of treatment over about a month.

For maintenance treatment, the list price for two 200 mg/mL prefilled syringes of Cimzia is $5,999.43. But your costs may be higher because of added fees, pharmacy pricing policies, and other factors.

What factors affect the cost of Cimzia?

Your actual out-of-pocket costs for Cimzia will depend on several factors, including:

• Location: If you’re getting Cimzia from a retail pharmacy, prices can vary by city. GoodRx research shows that people in Denver and Atlanta, for example, may pay less for prescription medications than people in New York and New Orleans.

• Pharmacy: Even pharmacies in the same neighborhood might charge differently for medications. Specialty pharmacies may have different pricing structures and negotiated prices, which can affect what you pay.

• Dosage: Your dosage depends on your medical condition and sometimes your weight. For example, children and adolescents with polyarticular juvenile idiopathic arthritis receive weight-based dosing, which can affect the overall costs.

• Insurance: If your insurance plan does cover Cimzia, you may still have financial responsibilities, including deductibles, copays, or coinsurance.

• Discounts: Savings programs, like manufacturer coupons or services such as GoodRx, can help lower your costs.

Does insurance cover Cimzia?

Most people enrolled in Affordable Care Act (ACA) marketplace plans have access to Cimzia, though coverage rates can vary depending on the dosage. The majority of these plans require prior authorization, and many enrollees must try other medications first (step therapy) before accessing Cimzia.

Commercial insurance plans cover Cimzia for most enrollees, but prior authorization is common, and some plans require step therapy.

Medicare rarely covers Cimzia, and prior authorization is almost always required. Nearly all Medicaid enrollees have coverage for Cimzia. But almost all will need prior authorization, and many go through step therapy.

EXPERT PICKS: WHAT TO READ NEXT

• Make the most of your HSA funds: See how you can use your health savings account (HSA) to cover Cimzia and other eligible expenses.

• Common Cimzia side effects include headache, joint pain, and fever. Here are other noteworthy Cimzia side effects and how to manage them. 

• Want to save on medication costs? Use these tips to keep your out-of-pocket prescription costs down.

To understand how your insurance covers Cimzia, check your health plan’s formulary or contact your insurer.

How different insurance plans cover Cimzia

The table below shows how likely Cimzia is to be covered and whether prior authorization or step therapy might be needed, depending on the type of insurance.

Source: Managed Markets Insight & Technology, LLC™, as of February 11, 2025. (See methodology below.)

Source: Managed Markets Insight & Technology, LLC™, as of February 11, 2025. (See methodology below.)

If your insurance doesn’t cover Cimzia, try the following:

• See if you qualify for financial assistance through a manufacturer’s savings program or the Patient Access Network (PAN) Foundation (details below).

• Ask your prescriber about other TNF inhibitors that may be covered by your insurance or have lower out-of-pocket costs.

• Request a formulary exception to have Cimzia covered. To do this, your prescriber may need to submit supporting documentation and a letter of medical necessity explaining why this medication is needed.

• If your formulary exception is denied, you have the right to appeal the decision.

• During the next open enrollment period, compare insurance plans to find one that offers better coverage for your medications.

Ways to save on Cimzia

Whether or not you have insurance, here are seven ways to save on Cimzia and, in some cases, get the medication at no cost:

1. Use a free GoodRx coupon

A free GoodRx coupon can reduce the cost of a Cimzia starter kit to as low as $5539.53. Many pharmacies accept these coupons, and you can use the GoodRx website or app to find one near you. 

To get your coupon: 

• Visit www.goodrx.com, or download the app.

• Search for “Cimzia.” 

• Click on “Find the lowest prices.” 

• Choose to receive your coupon by text or email, or print it out. 

Show the coupon when dropping off your prescription to get the savings and avoid delays at the pharmacy.

2. See if you qualify for the manufacturer’s savings program

With the CIMplicity savings card, you can pay as little as $0 for your Cimzia prescription.

To be eligible, you must:

• Have commercial insurance, and your insurance must cover the medication

• Have a valid prescription for Cimzia

• Use the medication as prescribed according to FDA-approved labeling

• Not be enrolled in a federal or state-funded healthcare program, like Medicare, Medicaid, or Tricare

If you receive Cimzia injections at a healthcare professional’s office, you may be eligible for the CIMplicity Administration Savings Program. This program helps cover the costs related to having your medication administered in the office, and your prescriber can help you complete an application. After your visit, you’ll need to submit an explanation of benefits to the CIMplicity program for reimbursement of eligible costs. 

3. Check if you qualify for UCB’s patient assistance program

If you don’t have insurance, you may qualify for help through UCB’s patient assistance program. UCB, the manufacturer of Cimzia, offers financial assistance to eligible individuals who have a valid prescription from a healthcare professional. This program is income based, and if you meet the requirements, you could receive Cimzia at no cost.

To learn more about the qualification criteria, call 1-866-395-8366. A program representative can walk you through the application process and explain the necessary documents. 

4. Look into the PAN Foundation

The PAN Foundation provides financial assistance for certain medications, including Cimzia. Eligibility depends on the health condition being treated, and you must generally meet certain residency, insurance, and income requirements.

Funding for these programs opens and closes throughout the year, but it’s worth checking their website regularly. You can enter your health condition to see if financial assistance is available.

5. Get a 90-day supply

Opting for a 90-day supply instead of a monthly refill of Cimzia might help reduce your long-term out-of-pocket costs. Many insurance plans offer lower copays or bulk pricing for 3-month prescriptions, even for those received through specialty pharmacies.

If Cimzia is covered under your plan, see if your insurer’s mail-order or specialty pharmacy provides savings on a 90-day supply. If they do, ask your prescriber to write a prescription for a 90-day quantity to take advantage of these potential savings.

6. Use your insurance’s preferred specialty pharmacy

If your insurance covers Cimzia and you’re getting it from a specialty pharmacy, make sure to use your insurer’s preferred pharmacy.

Using your plan’s preferred pharmacy may help reduce your out-of-pocket expenses and help you avoid higher costs associated with going out of network. Plus, specialty pharmacies can often help you find financial assistance. Check with your insurance provider for a list of preferred specialty pharmacies.

7. Tap into your HSA or FSA funds

Take advantage of the tax-free dollars in your health savings account (HSA) or flexible spending account (FSA) to cover your Cimzia prescription costs. Use your HSA or FSA payment card when ordering or picking up your medication, or retain your receipts to submit for reimbursement later. Paying for Cimzia with your FSA is a good way to use these funds before they expire.

Why trust our experts?

Written by:

Maggie Aime, MSN, RN

Maggie's writing brings health topics to life for readers at any stage of life. With over 25 years in healthcare and a passion for education, she creates content that informs, inspires, and empowers.

Edited by:

Charlene Rhinehart, CPA

Charlene Rhinehart, CPA, is a personal finance editor at GoodRx. She has been a certified public accountant for over a decade.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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Methodology

We obtained national prescription coverage data for each medication from Managed Markets Insight & Technology (MMIT). The data reflects health insurance coverage as of February 2025. 

We calculated the percentage of enrollees in plans that cover each medication by dividing the number of enrollees covered for the medication within a specific insurance channel (e.g., ACA, Medicare, Medicaid) by the total number of enrollees in all plans within that channel. 

We determined the percentage of enrollees in plans with a prior authorization requirement by calculating the proportion of enrollees in plans that required prior authorization for the medication within each channel. 

Finally, we measured the percentage of enrollees in plans with a step therapy requirement by calculating the proportion of enrollees in plans that imposed step therapy requirements for the medication in each channel. 

These estimates, derived from national MMIT coverage data, provide insight into health insurance coverage for each medication. They take into account restrictions such as prior authorization, step therapy, and quantity limits. The percentages are expressed relative to the total number of enrollees covered by various insurance channels, including ACA plans, commercial (excluding ACA) plans, Medicare, and Medicaid (both state-run and managed care plans).