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Kadcyla Medicare Coverage


Does Medicare cover Kadcyla?

87% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Kadcyla 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
$2765 – $3286
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
$691 – $3286
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$1244 – $3286
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 – $3286
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 Kadcyla

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

Manufacturer Coupon
Pay no more than $100 per treatment with insurance.
Patient Assistance Program
Receive your prescription at no charge if you are eligible.

Find Your Kadcyla 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 vial of Kadcyla 100mg

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $791
AARP MedicareComplete Plan 1 (HMO) $834
AARP MedicareComplete SecureHorizons (HMO) $770
AARP MedicareRx Preferred (PDP) $926
AARP MedicareRx Saver Plus (PDP) $723
Aetna Medicare Rx Saver (PDP) $733
Cigna-HealthSpring Preferred (HMO) $896
Cigna-HealthSpring Rx Secure (PDP) $715
Cigna-HealthSpring Rx Secure-Extra (PDP) $772
EnvisionRxPlus Silver (PDP) $712
Express Scripts Medicare - Value (PDP) $727
First Health Part D Value Plus (PDP) $968
Humana Enhanced (PDP) $951
Humana Preferred Rx Plan (PDP) $720
Humana Walmart Rx Plan (PDP) $720
Kaiser Permanente Senior Advantage (HMO) $1003
MedicareBlue Rx Standard (PDP)Lower price available $3286
SilverScript Choice (PDP) $991
Symphonix Value Rx (PDP) $725
WellCare Classic (PDP)Lower price available $3286
Don't see your Medicare plan above?

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

Kadcyla Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

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

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 Kadcyla typically on?

Tier 5

Medicare plans typically list Kadcyla 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.
GoodRx is not sponsored by or affiliated with any of the pharmacies identified in its price comparisons. All trademarks, brands, logos and copyright images are property of their respective owners and rights holders and are used solely to represent the products of these rights holders. This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. GoodRx is not offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. GoodRx provides no warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment.