Specialty Drug


IBRUTINIB is a medicine that targets proteins in cancer cells and stops the cancer cells from growing. It is used to treat mantle cell lymphoma, chronic lymphocytic leukemia, small lymphocytic lymphoma, marginal zone lymphoma, and Waldenstrom macroglobulinemia. Compare kinase inhibitors.

Ibrutinib Medicare Coverage


Does Medicare cover Imbruvica?

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

How much is my Imbruvica 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
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
$3192 – $4214
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
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 – $638
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 Ibrutinib

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

Patient Assistance Program
Receive your prescription at no charge if you are eligible.
Patient Assistance Program
Call to get more information on how they can financially assist you with your prescription.
Fill a 90-Day Supply to Save
You may be able to lower your total cost by filling a greater quantity at one time.

Find Your Ibrutinib 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 bottle (90 capsules) of Imbruvica 140mg

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $3482
AARP MedicareComplete Plan 1 (HMO) $3655
AARP MedicareComplete SecureHorizons (HMO) $3373
AARP MedicareRx Preferred (PDP) $4083
AARP MedicareRx Saver Plus (PDP) $3192
Aetna Medicare Rx Saver (PDP) $3192
Cigna-HealthSpring Preferred (HMO) $3916
Cigna-HealthSpring Rx Secure (PDP) $3192
Cigna-HealthSpring Rx Secure-Extra (PDP) $3447
EnvisionRxPlus Silver (PDP) $3192
Express Scripts Medicare - Value (PDP) $3192
First Health Part D Value Plus (PDP) $4214
Humana Enhanced (PDP) $4214
Humana Preferred Rx Plan (PDP) $3192
Humana Walmart Rx Plan (PDP) $3192
Kaiser Permanente Senior Advantage (HMO) $4214
MedicareBlue Rx Standard (PDP) $3192
SilverScript Choice (PDP) $4184
Symphonix Value Rx (PDP) $3192
WellCare Classic (PDP) $3192
Don't see your Medicare plan above?

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

Ibrutinib Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Imbruvica 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 Imbruvica typically on?

Tier 5

Medicare plans typically list Imbruvica 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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