Enfuvirtide
Specialty Drug

Fuzeon

ENFUVIRTIDE is an antiretroviral drug. It is used with other medicines to treat HIV. This medicine is not a cure for HIV. It will not stop the spread of HIV to others. Compare HIV entry inhibitors.

Enfuvirtide Medicare Coverage

Overview

Does Medicare cover Fuzeon?

Yes.
100% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Fuzeon co-pay with Medicare?

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

Deductible
Typical
Donut Hole
Post-Donut Hole
Co-Pay Range
$3207 – $3809
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
$45 – $1238
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$1443 – $1714
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 – $190
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 Enfuvirtide

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

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

Find Your Enfuvirtide 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 kit (60 vials) of Fuzeon 90mg

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $950
AARP MedicareComplete Plan 1 (HMO) $982
AARP MedicareComplete SecureHorizons (HMO) $918
AARP MedicareRx Preferred (PDP) $1100
AARP MedicareRx Saver Plus (PDP) $857
Aetna Medicare Rx Saver (PDP) $869
Cigna-HealthSpring Preferred (HMO) $1061
Cigna-HealthSpring Rx Secure (PDP) $860
Cigna-HealthSpring Rx Secure-Extra (PDP) $928
EnvisionRxPlus Silver (PDP) $864
Express Scripts Medicare - Value (PDP) $867
First Health Part D Value Plus (PDP) $1147
Humana Enhanced (PDP) $1132
Humana Preferred Rx Plan (PDP) $858
Humana Walmart Rx Plan (PDP) $857
Kaiser Permanente Senior Advantage (HMO) $45
MedicareBlue Rx Standard (PDP) $873
SilverScript Choice (PDP) $1147
Symphonix Value Rx (PDP) $856
WellCare Classic (PDP) $876
Don't see your Medicare plan above?

Find and configure your plan to see exact co-pay prices for your meds.

Enfuvirtide Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Fuzeon 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.

What drug tier is Fuzeon typically on?

Tier 5

Medicare plans typically list Fuzeon 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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