Specialty Drug
Myozyme is part of the Enzyme Replacement Therapies class and treats Lysosomal Storage Disease and Inherited Metabolic Diseases. Enzyme replacement therapies are used to treat lysosomal storage disease, pancreatic insufficiency, and PKU. They work by increasing levels of certain enzymes in the body to delay symptoms. Myozyme is only available as a brand name drug. Compare enzyme replacement therapies.

Myozyme Medicare Coverage

Overview

Does Medicare cover Myozyme?

Yes.
81% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Myozyme 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
$1001 – $1121
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
$250 – $1121
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$438 – $1121
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 – $1121
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 Myozyme

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

Lower Cost Alternative
Less expensive drugs that work the same way may be available.

Find Your Myozyme 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 Myozyme 50mg

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $275
AARP MedicareComplete Plan 1 (HMO) $289
AARP MedicareComplete SecureHorizons (HMO) $267
AARP MedicareRx Preferred (PDP) $322
AARP MedicareRx Saver Plus (PDP) $252
Aetna Medicare Rx Saver (PDP)Lower price available $1121
Cigna-HealthSpring Preferred (HMO)Lower price available $1112
Cigna-HealthSpring Rx Secure (PDP)Lower price available $1121
Cigna-HealthSpring Rx Secure-Extra (PDP)Lower price available $1121
EnvisionRxPlus Silver (PDP)Lower price available $1121
Express Scripts Medicare - Value (PDP) $255
First Health Part D Value Plus (PDP)Lower price available $1121
Humana Enhanced (PDP) $330
Humana Preferred Rx Plan (PDP) $250
Humana Walmart Rx Plan (PDP) $250
Kaiser Permanente Senior Advantage (HMO) $339
MedicareBlue Rx Standard (PDP) $266
SilverScript Choice (PDP) $351
Symphonix Value Rx (PDP) $253
WellCare Classic (PDP) $267
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Myozyme Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

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

Tier 5

Medicare plans typically list Myozyme 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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