How Much Is Tacrolimus Without Insurance?
Key takeaways:
In its oral form, tacrolimus is an immunosuppressive medication that reduces the risk of organ rejection after a transplant. The topical form of tacrolimus is sometimes prescribed to treat eczema.
Without insurance, 60 capsules of generic 1 mg tacrolimus costs an average of $167.04. The exact price you’ll pay will depend on your prescribed dosage, your dosage form, the fill amount, your geographic location, the pharmacy you use, and whether you take the generic or brand-name version.
If you don't have insurance or your plan doesn't cover tacrolimus, there are a number of ways to save on the medication. You can use a GoodRx coupon, compare costs at different pharmacies, and explore patient assistance programs. You also can ask your healthcare professional about alternative medications.
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Table of contents
Organ transplants can be life-saving procedures for people living with end-stage renal disease and other conditions. But organ rejection is a serious, possible complication of organ transplants, which is why medications that prevent rejection are so important.
In its oral form, tacrolimus is an immunosuppressive medication, which works by limiting the activity of the immune system to prevent rejection of certain organs, including transplanted livers, hearts, lungs, and kidneys. The topical form of the medication is also sometimes prescribed to treat eczema, though it’s not a first-choice treatment for the condition. Tacrolimus blocks an immune system protein called calcineurin, which normally contributes to the formation of eczema.
Tacrolimus basics
Prograf is one brand-name version of oral tacrolimus, which comes as a capsule and topical medication. Astagraf XL and Envarsus XR are brand-name, extended-release versions of oral tacrolimus.
The chart below provides a summary of basic information about tacrolimus.
Tacrolimus Basics
| Generic name | Tacrolimus |
| Brand names | Astagraf XL, Envarsus XR, Prograf |
| Forms |
|
| Doses | The capsules come in three doses: 0.5 mg, 1 mg, and 5 mg. The topical version comes in two doses: 0.03% and 0.1%. Typically, adults are instructed to apply a thin layer of the ointment to the affected area twice a day. |
| FDA-approved uses |
|
| Benefits |
|
| Possible side effects, both common and rare | Oral tacrolimus side effects
Topical tacrolimus side effects
Topical and oral forms of tacrolimus carry an FDA boxed warning, which is the agency’s most serious medication warning. The warning for the topical version — which is not a first-choice treatment for eczema and is not recommended for children younger than 2 — is for a potential increased risk of cancer. The warning for the oral version is for a potential risk of serious infections and cancer. Astagraf XL, specifically, also shouldn’t be used by those seeking a liver transplant. |
A note about tacrolimus dosages
Dosages of oral tacrolimus depend on why the medication is being taken. Immediate-release tacrolimus (Prograf) dosages vary from other formulations. Body weight also plays a role.
For example, the initial recommended oral dosage for an adult after a liver transplant is 0.10 mg to 0.15 mg per kilogram of body weight per day — taken in 2 doses, 12 hours apart. In contrast, the initial recommended oral dosage for an adult after a heart transplant is 0.075 mg per kilogram of body weight per day — taken in 2 doses, 12 hours apart.
Is tacrolimus covered by insurance?
Most health insurance plans cover both the oral and topical forms of generic tacrolimus. Though, coverage may depend on the reason for treatment. Check your plan’s summary of benefits and coverage and formulary to determine whether tacrolimus is covered.
This medication is also typically covered under Medicare’s immunosuppressive drug benefit. This benefit ensures immunosuppressive medications are covered for kidney recipients who qualified for Medicare specifically because they had end-stage renal disease and have no prescription coverage 36 months after a successful transplant. Accessing this benefit requires enrollees to pay an extra premium.
How insurance covers tacrolimus
Some health insurance plans that cover tacrolimus require enrollees to get a prior authorization or do step therapy. For the ointment, a prior authorization is required for nearly 50% of Medicaid enrollees, as well as 20% of people with Medicare and Affordable Care Act (ACA) plans. About 20% of people in ACA plans — and 25% of enrollees in other commercial plans, as well as 25% of Medicare enrollees — can expect to be required to do step therapy.
Tacrolimus side effects: Tacrolimus, most often prescribed to prevent organ transplant rejection, can cause many side effects. But there are steps you can take to reduce your likelihood of experiencing them.
Comparing treatments for eczema: Check out this head-to-head comparison of tacrolimus and triamcinolone, which can both be prescribed to treat eczema.
Tacrolimus interactions: Certain antibiotics, blood pressure medications, and antacids should be used with caution if you take tacrolimus.
Nearly 70% of Medicare prescription medication insurance enrollees are required to get a prior authorization for tacrolimus capsules.
The following charts show the percentage of enrollees who have coverage — as well as prior authorization and step therapy requirements — for two forms of tacrolimus across various plans.
Insurance Coverage for Tacrolimus 0.03% Ointment
Insurance type | Enrollees covered for tacrolimus 0.03% ointment | Enrollees required to get a prior authorization | Enrollees required to do step therapy |
|---|---|---|---|
Commercial (not including plans purchased through an ACA marketplace) | 99.2% | 2.9% | 23.1% |
99.4% | 21% | 18.38% | |
Medicare, including original Medicare and Medicare Advantage plans | 99.6% | 20.1% | 24.55% |
Medicaid, including state-run and managed care plans | 99.8% | 45.7% | 4.96% |
Source: Managed Markets Insight & Technology, LLC™, as of January 6, 2025. (See methodology below.)
Insurance Coverage for Tacrolimus 1 mg Capsules
Insurance type | Enrollees covered for tacrolimus 1 mg capsules | Enrollees required to get a prior authorization | Enrollees required to do step therapy |
|---|---|---|---|
Commercial (not including plans purchased through an ACA marketplace) | 98.9% | 1.6% | 0.62% |
ACA plans | 99.5% | 1.6% | 0.31% |
Medicare, including original Medicare and Medicare Advantage plans | 99.9% | 68.5% | 0% |
Medicaid, including state-run and managed care plans | 98.3% | 7.1% | 0% |
Source: Managed Markets Insight & Technology, LLC™, as of January 6, 2025. (See methodology below.)
Tips if your medication isn’t covered by insurance
If your insurance doesn’t cover tacrolimus, here are a few options to try:
Talk to your prescriber about alternative medications that may be covered by your plan.
Ask for a formulary exception from your plan to get coverage for tacrolimus. Keep in mind that you may be required to do step therapy or get a prior authorization to be covered.
If you request a formulary exception and it is denied, file an appeal with your plan.
Use a GoodRx coupon for potential savings.
Consider changing your prescription medication coverage during your next open enrollment period.
Check to see if there are patient assistance programs that offer discounted or free medication.
How much does tacrolimus cost without insurance?
If you don’t have health insurance, what you’ll pay for tacrolimus will depend on factors such as:
Your prescribed dosage
Your dosage form (e.g., tablet, capsule, or ointment)
The fill amount
Your geographic location
The pharmacy you use
The chart below details the average retail prices for various doses and quantities of generic tacrolimus capsules and ointments. Keep in mind that brand-name versions of medications typically cost more than the generic versions.
Tacrolimus Costs
Doses and quantities | Average retail price (generic formulations) |
|---|---|
Capsules, 0.5 mg (60 capsules) | |
Capsules, 1 mg (60 capsules) | |
Capsules, 5 mg (60 capsules) | |
Ointment (30 g of 0.03%), 1 tube | |
Ointment (60 g of 0.03%), 1 tube | |
Ointment (100 g of 0.03%), 1 tube | |
Ointment (30 g of 0.1%), 1 tube | |
Ointment (60 g of 0.1%), 1 tube | |
Ointment (100 g of 0.1%), 1 tube |
Ways to save on tacrolimus without insurance
Although tacrolimus can be a low-cost medication even without insurance, there are still potential ways to save money on your prescription. Here are five strategies to consider.
1. Use a GoodRx coupon
With a GoodRx coupon, you may be able to pay a lower price for your tacrolimus prescription. At certain pharmacies, you may be able to get 60 capsules of generic 1 mg tacrolimus for as low as $19.80 with a GoodRx coupon.
Here’s how to get a coupon:
Visit www.goodrx.com or install the GoodRx app on your mobile device.
Type “tacrolimus” in the search field.
Choose your correct quantity and location.
Click or tap on “Search prices” to find prices at pharmacies near you.
Choose to receive your coupon via text or email, or print it out.
Show the coupon at your pharmacy when you pick up your medication. Or present the coupon to your pharmacy staff when you first receive your prescription. This will help prevent delays at the pickup counter.
2. Compare prices at various pharmacies
GoodRx can help you easily compare costs at different pharmacies in your area so that you can find the best price for tacrolimus.
3. Ask your prescriber about alternatives
If you are concerned about the cost of tacrolimus, talk to your prescriber. There may be another medication that adequately treats your condition and better fits your budget.
4. Use tax-advantaged healthcare funds
If you have a health savings account (HSA), a flexible spending account (FSA), or a health reimbursement arrangement (HRA), using those funds to buy your medication can reduce your out-of-pocket costs through tax savings.
5. Look into discount and financial assistance programs
There may be funds available to help you pay for tacrolimus depending on why you need the medication. The National Kidney Foundation provides a list of prescription discount and financial assistance programs available to people who have had a kidney transplant. For example, Veloxis Pharmaceuticals, the company that manufactures Envarsus XR, offers a copay savings card to eligible people with commercial insurance that covers up to the entire cost of their copay.
The bottom line
The oral form of tacrolimus (Prograf, Astagraf XL, Envarsus XR) is prescribed to prevent organ transplant rejection, while the topical form is a second-choice eczema treatment. Most insurance plans cover tacrolimus, but you may be subject to prior authorization or step therapy requirements.
If you don’t have insurance, the cost of 60 capsules of 1 mg tacrolimus averages about $167.04. But you may be able to save money by comparing pharmacy prices, asking your prescriber about alternative medications that cost less, or using a GoodRx coupon. There also may be savings available if you apply for a manufacturer copay savings card.
Why trust our experts?
Methodology
We obtained national prescription coverage data for each medication from Managed Markets Insight & Technology (MMIT). The data reflects health insurance coverage as of January 2025.
We calculated the percentage of enrollees in plans that cover each medication by dividing the number of enrollees covered for the medication within a specific insurance channel (e.g., ACA, Medicare, Medicaid) by the total number of enrollees in all plans within that channel.
We determined the percentage of enrollees in plans with a prior authorization requirement by calculating the proportion of enrollees in plans that required prior authorization for the medication within each channel.
Finally, we measured the percentage of enrollees in plans with a step therapy requirement by calculating the proportion of enrollees in plans that imposed step therapy requirements for the medication in each channel.
These estimates, derived from national MMIT coverage data, provide insight into health insurance coverage for each medication. They take into account restrictions such as prior authorization, step therapy, and quantity limits. The percentages are expressed relative to the total number of enrollees covered by various insurance channels, including ACA plans, commercial (excluding ACA) plans, Medicare, and Medicaid (both state-run and managed care plans).
References
American Academy of Dermatology Association. (2023). Eczema types: Atopic dermatitis overview.
Astellas Pharma US. (2012). Prograf (tacrolimus) capsules; Prograf (tacrolimus) injection (for intravenous use).
Astellas Pharma US. (2023). Astragraf XL - tacrolimus extended-releases capsules capsule, coated, extended release [package insert].
Astellas Pharma US. (2023). Prograf (tacrolimus) capsules, for oral use; Prograf (tacrolimus) injection, for intravenous use; Prograph granules (tacrolimus for oral suspension).
CMS.gov. (2024). Medicare Part B immunosuppressive drug benefits. Centers of Medicare & Medicaid Services.
Encube Ethicals. (2023). Tacrolimus - tacrolimus ointment [package insert]. DailyMed.
Envarsus XR. (n.d.). Savings and support.
John Hopkins Medicine. (n.d.). End stage renal disease (ESRD).
Medicaid.gov. (n.d.). Managed care.
MedlinePlus. (2023). Tacrolimus.
MedlinePlus. (2024). Tacrolimus topical.
National Eczema Society. (n.d.). Topical calcineurin inhibitors (TCIs).
National Kidney Foundation. (n.d.). Prescription discount and assistance resources.
United Network for Organ Sharing. (n.d.). Tacrolimus.
U.S. Food and Drug Administration. (2015). FDA approved updated labeling with boxed warning and medication guide for two eczema drugs, Elidel and Protopic.
U.S. Food and Drug Administration. (2015). Tacrolimus (marketed as Protopic ointment) information.
U.S. Food and Drug Administration. (2023). Questions and answers regarding tacrolimus oral capsules (generic of Prograf), made by Accord Healthcare Inc.
Veloxis Pharmaceuticals. (2024). Evarsus X - tacrolimus tablet, extended release. DailyMed.
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