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Kalydeco Medicare Coverage


Does Medicare cover Kalydeco?

90% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Kalydeco 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
$6870 – $9069
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 – $1374
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 Kalydeco

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

Patient Assistance Program
Save at least $5 per month on your prescription.

Find Your Kalydeco 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 carton (56 packets) of Kalydeco 75mg

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $7493
AARP MedicareComplete Plan 1 (HMO) $7866
AARP MedicareComplete SecureHorizons (HMO) $7259
AARP MedicareRx Preferred (PDP) $8787
AARP MedicareRx Saver Plus (PDP) $6870
Aetna Medicare Rx Saver (PDP) $6870
Cigna-HealthSpring Preferred (HMO) $8428
Cigna-HealthSpring Rx Secure (PDP) $6870
Cigna-HealthSpring Rx Secure-Extra (PDP) $7420
EnvisionRxPlus Silver (PDP) $6870
Express Scripts Medicare - Value (PDP) $6870
First Health Part D Value Plus (PDP) $9069
Humana Enhanced (PDP) $9069
Humana Preferred Rx Plan (PDP) $6870
Humana Walmart Rx Plan (PDP) $6870
Kaiser Permanente Senior Advantage (HMO) $9069
MedicareBlue Rx Standard (PDP) $6870
SilverScript Choice (PDP) $9004
Symphonix Value Rx (PDP) $6870
WellCare Classic (PDP) $6870
Don't see your Medicare plan above?

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

Kalydeco Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

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

Tier 5

Medicare plans typically list Kalydeco 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.