It depends. Which coverage stage are you in? Click on a tab below…
Here are some ways that may lower the cost of your Orkambi prescription.
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.
|Medicare Plan Name||Average Co-Pay|
|AARP MedicareRx Preferred (PDP)||$9543|
|AARP MedicareRx Saver Plus (PDP)||$6014|
|AARP MedicareRx Walgreens (PDP)||$6014|
|Aetna Medicare Rx Saver (PDP)||$6014|
|Anthem Blue Cross MedicareRx Plus (PDP)||$7939|
|Anthem MediBlue Essential (HMO)||$7458|
|CareMore Value Plus (HMO)||$13312|
|Cigna-HealthSpring Preferred (HMO)||$6705|
|Express Scripts Medicare - Choice (PDP)||$6255|
|Express Scripts Medicare - Value (PDP)||$6014|
|First Health Part D Value Plus (PDP)||$7939|
|Humana Enhanced (PDP)||$7939|
|Humana Preferred Rx Plan (PDP)||$6014|
|Humana Walmart Rx Plan (PDP)||$6014|
|Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost)||$7939|
|MedicareBlue Rx Standard (PDP)||$6014|
|SilverScript Plus (PDP)||$7939|
|Symphonix Value Rx (PDP)||$6014|
|TexanPlus Classic (HMO)||$20028|
Find and configure your plan to see exact co-pay prices for your meds.
Some Medicare plans have restrictions on coverage of Orkambi that may include:
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.
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.
Medicare plans typically list Orkambi 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.
See discount prices that can save you money when your Medicare plan doesn't work for you.