How Much Is Tacrolimus Without Insurance?

Tacrolimus is a prescription medication that helps prevent the body from rejecting a transplanted organ. It works by suppressing the immune system, which lowers the risk of rejection.

Tacrolimus is available in several forms. Oral tacrolimus (Prograf, Envarsus XR, Astagraf XL) is commonly used after liver, kidney, or heart transplants. It comes in immediate-release (IR), extended-release (ER), and oral liquid forms. A topical form (Protopic) may be prescribed for eczema, but it isn’t a first-choice treatment.

If you’ve been prescribed tacrolimus, understanding how much it costs and ways to save can help you manage this important medication more affordably.

How much does tacrolimus cost?

Without insurance or discounts, 60 capsules of generic 1 mg tacrolimus costs an average of $140.45. One 60 g tube of generic tacrolimus 0.03% ointment costs an average of $496.65.

For oral tacrolimus, your dosage is highly personalized. It requires ongoing monitoring to ensure the medication is safe and effective. The IR capsule (Prograf) and ER capsules (Astagraf XL) are available as brand-name medications and lower-cost generics. The ER tablet (Envarsus XR) and oral liquid (Prograf) are brand-name only.

For topical tacrolimus, there are two concentrations: 0.03% and 0.1%. The ointment is applied twice daily. How long a tube will last depends on the size of the affected area. Both brand-name and generic forms are available.

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.

Which factors affect the cost of tacrolimus?

Several factors can affect how much you’ll pay for tacrolimus, including:

• Insurance: Most insurance plans cover oral and topical forms of tacrolimus. But your out-of-pocket cost can vary based on factors such as your deductible, copay, and coinsurance.

• Dosage and formulation: Your dosage and the form you’re prescribed can affect how much you pay for tacrolimus. Higher doses typically cost more than lower doses. And the ER tablet and oral liquid don’t have generics, so they may be more expensive.

• Discounts: Save money on your tacrolimus prescription by using a discount from GoodRx, regardless of your insurance status. A manufacturer copay savings card or patient assistance program may be available for brand-name products.

• Pharmacy: Medication prices can vary across pharmacies. So it pays to compare prices to find the best deal.

Is tacrolimus covered by insurance?

Most health insurance plans cover both oral and topical forms of generic tacrolimus. But 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.

Oral tacrolimus 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.

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 can expect to be required to do step therapy. So can 25% of enrollees in other commercial plans, as well as 25% of Medicare enrollees.

Nearly 70% of Medicare prescription medication insurance enrollees are required to get a prior authorization for tacrolimus capsules.

Ways to save on tacrolimus

Even though most forms of tacrolimus are available as lower-cost generics, there are still potential ways to save money on your prescription. Here are five strategies to consider.

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 that are available to people who’ve 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 (Protopic) 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 $140.45. One 60 g tube of generic tacrolimus 0.03% ointment costs an average of $496.65. But you may be able to save money by using a GoodRx coupon. There also may be savings available if you apply for a manufacturer copay savings card.

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Written by:

Tamara E. Holmes

Tamara E. Holmes is a Washington, DC-based freelance journalist and content strategist who has been writing about personal finance, health, and health insurance for more than a decade. Her work has appeared in various print and online publications, such as USA Today, AARP, Working Mother, and Diversity Woman.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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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).