Specialty Drug
IMATINIB is a medicine that targets proteins in cancer cells and stops the cancer cells from growing. It is used to treat certain leukemias, myelodysplastic syndromes, and other cancers. It is also used to treat specific digestive tract tumors called GISTs. Compare kinase inhibitors.

Imatinib Medicare Coverage

Overview

Does Medicare cover imatinib?

Yes.
80% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my imatinib 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
$6405 – $9401
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
$10 – $7230
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$10 – $7230
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
$5 – $7230
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 Imatinib

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

Manufacturer Coupon
Pay as little as $10 per prescription.
Patient Assistance Program
Receive your prescription at no charge if you are eligible.

Find Your Imatinib 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 30 tablets of imatinib 400mg

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $1746
AARP MedicareComplete Plan 1 (HMO) $1833
AARP MedicareComplete SecureHorizons (HMO) $1692
AARP MedicareRx Preferred (PDP) $2054
AARP MedicareRx Saver Plus (PDP) $1614
Aetna Medicare Rx Saver (PDP) $2350
Cigna-HealthSpring Preferred (HMO) $2467
Cigna-HealthSpring Rx Secure (PDP) $2051
Cigna-HealthSpring Rx Secure-Extra (PDP) $2215
EnvisionRxPlus Silver (PDP)Lower price available $7230
Express Scripts Medicare - Value (PDP) $2307
First Health Part D Value Plus (PDP) $2839
Humana Enhanced (PDP)Lower price available $7230
Humana Preferred Rx Plan (PDP)Lower price available $7230
Humana Walmart Rx Plan (PDP)Lower price available $7230
Kaiser Permanente Senior Advantage (HMO) $10
MedicareBlue Rx Standard (PDP) $1807
SilverScript Choice (PDP) $2369
Symphonix Value Rx (PDP) $1835
WellCare Classic (PDP) $1807
Don't see your Medicare plan above?

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

Imatinib Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

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

Tier 5

Medicare plans typically list imatinib 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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