Kuvan
Specialty Drug

Sapropterin

SAPROPTERIN works to lower phenylalanine levels in the blood. It is used with a special diet to treat phenylketonuria. This medicine is not a cure. Compare enzyme replacement therapies.

Kuvan Medicare Coverage

Overview

Does Medicare cover Kuvan?

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

How much is my Kuvan 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
$1936 – $2161
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
$484 – $2139
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$696 – $981
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
$97 – $109
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 Kuvan

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

Manufacturer Coupon
Get a 30 day free trial.
Patient Assistance Program
Contact BioMarin Patient & Physician Support (BPPS) by phone or email to get more information on how they can financially assist you with your prescription.
When Will the Generic Be Available?
Some or all forms of Kuvan may become available as generic sapropterin after November 2025, depending on FDA approval and patent expiration.

Find Your Kuvan 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 240 tablets of Kuvan 100mg

Medicare Plan Name Average Co-Pay
AARP MedicareRx Preferred (PDP) $836
AARP MedicareRx Saver Plus (PDP) $526
AARP MedicareRx Walgreens (PDP) $524
Aetna Medicare Rx Saver (PDP) $522
Anthem Blue Cross MedicareRx Plus (PDP) $656
Anthem MediBlue Essential (HMO) $637
CareMore Value Plus (HMO) $1157
Cigna-HealthSpring Preferred (HMO) $590
EnvisionRxPlus (PDP) $517
Express Scripts Medicare - Choice (PDP) $531
Express Scripts Medicare - Value (PDP) $511
First Health Part D Value Plus (PDP) $689
Humana Enhanced (PDP) $649
Humana Preferred Rx Plan (PDP) $492
Humana Walmart Rx Plan (PDP) $492
Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost) $693
MedicareBlue Rx Standard (PDP) $515
SilverScript Plus (PDP) $705
Symphonix Value Rx (PDP) $526
TexanPlus Classic (HMO) $1780
Don't see your Medicare plan above?

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Kuvan Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

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

Tier 5

Medicare plans typically list Kuvan 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). They are accurate as-of January 2017 and the information may be updated. If you encounter any issues, please let us know.
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