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Perjeta Medicare Coverage


Does Medicare cover Perjeta?

70% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Perjeta 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
$4490 – $11193
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
$1122 – $11193
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$1541 – $11193
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
$224 – $11193
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 Perjeta

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

Manufacturer Coupon
Pay no more than $100 per treatment with insurance.
Patient Assistance Program
Receive your prescription at no charge if you are eligible.

Find Your Perjeta 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 2 vials 420mg/14ml of Perjeta

Medicare Plan Name Average Co-Pay
AARP MedicareRx Preferred (PDP) $1916
AARP MedicareRx Saver Plus (PDP) $1208
AARP MedicareRx Walgreens (PDP) $1195
Aetna Medicare Rx Saver (PDP) $1195
Anthem Blue Cross MedicareRx Plus (PDP) $1513
Anthem MediBlue Essential (HMO) $1461
CareMore Value Plus (HMO) $2629
Cigna-HealthSpring Preferred (HMO) $1354
EnvisionRxPlus (PDP)Lower price available $11193
Express Scripts Medicare - Choice (PDP) $1215
Express Scripts Medicare - Value (PDP) $1169
First Health Part D Value Plus (PDP) $1577
Humana Enhanced (PDP)Lower price available $11193
Humana Preferred Rx Plan (PDP)Lower price available $11193
Humana Walmart Rx Plan (PDP)Lower price available $11193
Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost) $1638
MedicareBlue Rx Standard (PDP)Lower price available $11193
SilverScript Plus (PDP)Lower price available $11193
Symphonix Value Rx (PDP) $1210
TexanPlus Classic (HMO)Lower price available $11193
Don't see your Medicare plan above?

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

Perjeta Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

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

Tier 5

Medicare plans typically list Perjeta 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.
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.
In all states except Tennessee, GoodRx is considered a marketer of prescription discount cards, and is not required to register as a discount card provider. In Tennessee, GoodRx is registered as a Prescription Drug Discount Plan Operator.
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