How Much Is Kesimpta Without Insurance?

Insurance coverage

If you have prescription insurance, how much you’ll pay for Kesimpta will depend on whether it’s a covered medication. It will also depend on where it’s placed within your plan’s formulary (list of covered medications). Most insurance plans have tiers, or levels, within their formulary. Lower-tier medications typically have a lower copay than medications in a higher tier.

In some cases, your insurer may also require prior authorization or step therapy before they’ll cover Kesimpta. A prior authorization requirement means your prescriber must provide information to your insurer to get approval for the medication. Step therapy requires you to try one or more lower-cost treatments — or explain why they aren’t an option — before coverage is approved.

Dosage form and quantity

The price of Kesimpta may vary depending on whether you’re using the syringe or the autoinjector.

Your Kesimpta costs may also be higher for the first month of treatment. That’s because you’ll inject Kesimpta once a week for the first 3 weeks before switching to once-monthly injections. So you’ll need to pay for 3 doses instead of just 1 for the first month.

Reference vs. biosimilar availability

Kesimpta is only available as a reference (“brand-name”) biologic. Once approved, a Kesimpta biosimilar (the biologic version of a lower-cost generic) may help you save money on your prescription. But no biosimilars for Kesimpta are available at this time.

Location

Where you live can affect what you pay out-of-pocket for medications. Costs may vary by state or region due to differences in pharmacy pricing and supply. For instance, prices for prescription medications are generally lower in Tampa, Florida, than in New York City.

Pharmacy

Kesimpta is usually filled through a specialty pharmacy. Specialty pharmacy staff are typically trained to help you find ways to make your prescription more affordable. But different pharmacies may have different cash prices or available discounts, so it’s worth comparing options if possible.

Keep in mind that some insurance providers require members to use a specific specialty pharmacy. So this may not always be an option.

1. See if you qualify for a copay savings card

If you have commercial insurance, you could pay as little as $0 per month for Kesimpta using a copay savings card from the manufacturer. There is an annual savings limit of $18,000. To be eligible, you must:

• Have commercial insurance coverage for Kesimpta

• Not have government-funded insurance, such as Medicaid, Medicare, or Tricare

• Be a resident of the U.S. or Puerto Rico

You could also access Kesimpta at no cost for up to 12 months (1 year) while you’re waiting for your insurance to approve Kesimpta. This is known as a bridge program, and it helps prevent delays in starting treatment due to insurance-related logistics.

You can sign up for the Alongside Kesimpta Access Card online or by calling 1-855-537-4678.

2. Check if you’re eligible for a patient assistance program

Novartis, the manufacturer of Kesimpta, also offers a patient assistance program. It provides Kesimpta at no cost to those who are uninsured or underinsured and meet certain income requirements.

You can get more information by calling 1-800-277-2254. Keep in mind that your prescriber will need to provide paperwork to Novartis as part of this program. So be sure to loop in your healthcare team if you’re applying.

Several nonprofit organizations also offer patient assistance programs that could help lower your costs. These are often catered to people living with a specific health condition, and each program has its own eligibility criteria. Examples of organizations that offer these programs include:

• The Assistance Fund

• Patient Access Network (PAN) Foundation

• Patient Advocate Foundation

• HealthWell Foundation

Keep in mind that you may need to join a waitlist if a program isn’t currently accepting new applicants.

3. Apply for Extra Help through Medicare

If you have coverage through Medicare, you can also look into the Extra Help program. It could reduce your out-of-pocket costs if you meet certain income and resource requirements. You can apply for this program in three different ways:

1. Online at ssa.gov/medicare/part-d-extra-help

2. By calling 1-800-772-1213

3. In person at a local Social Security office

4. Ask about a 90-day supply

If you have insurance, your plan may offer Kesimpta at a lower monthly cost if you fill a 90-day (3-month) supply instead of 1 month at a time. Contact your specialty pharmacy or prescription insurance plan to see if this applies to you.

5. Tap into your HSA, FSA, or HRA

If you have a health savings account (HSA), a flexible spending account (FSA), or a health reimbursement arrangement (HRA), you can use it to help cover your out-of-pocket costs for Kesimpta. These tax-advantaged healthcare accounts let you pay for eligible expenses with tax-free dollars.

Pay for your medication directly with your HSA or FSA card, or cover the cost yourself and submit a request for reimbursement. The funds in HSAs and HRAs typically roll over annually, but you have to use FSA dollars before the deadline or they’ll expire.

Why trust our experts?

Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Our editorial standards

Meet our experts