Perjeta
Specialty Drug

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Perjeta Medicare Coverage

Overview

Does Medicare cover Perjeta?

Yes.
75% 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…

Deductible
Typical
Donut Hole
Post-Donut Hole
Co-Pay Range
$4255 – $5122
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
$1064 – $5122
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$1915 – $5122
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 – $5122
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 1 vial 420mg/14ml of Perjeta

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $1218
AARP MedicareComplete Plan 1 (HMO) $1279
AARP MedicareComplete SecureHorizons (HMO) $1183
AARP MedicareRx Preferred (PDP) $1419
AARP MedicareRx Saver Plus (PDP) $1109
Aetna Medicare Rx Saver (PDP) $1124
Cigna-HealthSpring Preferred (HMO) $1354
Cigna-HealthSpring Rx Secure (PDP) $1095
Cigna-HealthSpring Rx Secure-Extra (PDP) $1183
EnvisionRxPlus Silver (PDP)Lower price available $5122
Express Scripts Medicare - Value (PDP) $1116
First Health Part D Value Plus (PDP) $1484
Humana Enhanced (PDP)Lower price available $5122
Humana Preferred Rx Plan (PDP)Lower price available $5122
Humana Walmart Rx Plan (PDP)Lower price available $5122
Kaiser Permanente Senior Advantage (HMO) $1543
MedicareBlue Rx Standard (PDP)Lower price available $5122
SilverScript Choice (PDP)Lower price available $5122
Symphonix Value Rx (PDP) $1112
WellCare Classic (PDP)Lower price available $5122
Don't see your Medicare plan above?

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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). If you encounter any issues, please let us know.
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