Dupixent is a medicine used to treat certain chronic inflammatory diseases like eczema and asthma. As with any prescription medication, its cost is an important factor for many patients.
Before diving into costs, let’s briefly discuss what Dupixent is and how it works. Dupixent (generic name dupilumab) is a monoclonal antibody designed to block the interleukin-4 and interleukin-13 pathways, which are important drivers of type 2 inflammation. By blocking these pathways, Dupixent helps reduce inflammation and related symptoms in conditions like atopic dermatitis (eczema), asthma, chronic rhinosinusitis with nasal polyposis, and eosinophilic esophagitis.
Dupixent was first accredited by the FDA in 2017 to treat severe or minor atopic dermatitis in adults. It has since gained approvals for additional conditions and age groups. Clinical trials found Dupixent provided significant breakthroughs in symptoms and quality of life for patients with these chronic inflammatory diseases when other treatments were not well-controlled or tolerated. As an injectable biologic therapy, Dupixent requires a prescription from a healthcare provider. It is produced and marketed by Sanofi and Regeneron Pharmaceuticals.
How Dupixent Works at a Technical Level
To understand Dupixent’s expected costs, it helps to briefly explain how it works at a technical level. Dupixent is a monoclonal antibody, which is an engineered antibodies that only target a single, specific antigen. In Dupixent’s case, the targets are interleukin-4 and interleukin-13, two key proteins (cytokines) involved in type 2 inflammation.
Interleukins are a group of cytokines that help coordinate communication between white blood cells during immune and inflammatory responses. Specifically, IL-4 and IL-13 are classified as type 2 cytokines that amplify allergic inflammation. They work by binding to the alpha subunit of the IL-4 receptor, which initiates downstream cellular signaling pathways that promote inflammatory gene expression.
By blocking the ability of IL-4 and IL-13 to bind to their receptor, Dupixent prevents these pro-inflammatory signals and halts the type 2 immune cascade at an early point. This modulates the inflammatory response underlying conditions like atopic dermatitis, asthma, chronic rhinosinusitis, and eosinophilic esophagitis. Understanding Dupixent’s mechanism of action provides valuable context for its potential costs.
Dupixent Costs with Insurance
Before getting into costs without insurance, let’s first discuss Dupixent’s typical reimbursement when a patient has coverage. The list price for Dupixent is quite high, but most insured patients in the US pay far less, thanks to negotiated rates between manufacturers and insurance providers.
List Price vs Insured Cost
The list price for a monthly dose of Dupixent is approximately $3,700. However, the actual price paid is lower for most insured patients due to secret rebates and discounts negotiated behind the scenes. On average, copays for Dupixent with commercial insurance range from $25-250 per monthly prescription. Those with Medicare Part D plans may pay around $70 with supplemental coverage.
Drug makers are not required to disclose negotiated rebates and discounts provided to insurance plans. These can significantly reduce the reimbursement rate insurers pay manufacturers while also lowering costs for patients. For example, a study estimated the average rebate provided for Dupixent was around 53% of the list price in 2020.
There is variability in Dupixent coverage between different insurance plans based on factors like:
- Deductible amount – Higher deductibles mean more is paid out-of-pocket before coverage kicks in.
- Copay/coinsurance structure – Some plans use copays while others require coinsurance, like 20% of the drug cost.
- Restrictions/prior authorization – Full coverage may require trying cheaper alternatives first.
- Formulary tier – Specialty drugs often have the highest copays if not on the preferred tier.
So while the typical insured patient pays far less than the list, there is some variance depending on an individual’s coverage details. Out-of-pocket costs can range from a $25 copay to several hundred dollars per month before reaching yearly limits.
Dupixent Costs without Insurance
For the uninsured, paying full price or attempting to get Dupixent at a discount is the only option. Here’s a breakdown of potential out-of-pocket costs patients may face without coverage in 2024 based on current price trends:
Projected List Price in 2024
To project Dupixent’s list price in 2024 without factoring in potential rebates or assistance programs:
- The current monthly list price is around $3,700 already in 2023.
- On average, list prices for specialty drugs increase by 5-10% annually.
- Using a conservative estimate of a 5% annual increase, Dupixent’s projected 2024 monthly list price would be approximately $3,885 without insurance.
- For a full year of treatment, the projected total at the list price in 2024 would be around $46,620 without coverage.
Of course, very few, if any, uninsured patients actually pay the full list price due to patient assistance programs and other discounts available.
Here are some ways uninsured patients may be able to get Dupixent at a lower cost:
Patient Assistance Programs
Both Sanofi and Regeneron offer patient assistance programs for uninsured or underinsured patients making below 500% of the federal poverty level. This can provide Dupixent at no cost or a greatly reduced copay, depending on income qualifications.
The drug makers offer coupons that can be used at the pharmacy to reduce out-of-pocket costs for the uninsured. Savings may range from 35-75% off the total price.
Uninsured patients can check prices at local independent pharmacies, which sometimes offer additional discounts for cash-paying customers without insurance. Savings may reach 25-40% in some cases.
Consider purchasing Dupixent from an international online pharmacy in countries where it sells for far less. Significant discounts are possible, but this route involves some risks.
So, in summary, while projections put Dupixent’s 2024 list price near $3,885/month without insurance, various discounts and assistance programs could potentially cut costs by 35-100% depending on the individual’s financial situation and strategies used. With help, some uninsured patients may pay closer to average insured copays of $25-250 per month.
A few other factors are important to consider regarding Dupixent’s affordability without insurance:
Medical Bill Assistance
Non-profit organizations offer help reducing or eliminating medical debt for the uninsured. Resources like financial assistance funds, flexible payment plans, and healthcare bill negotiators can potentially lower Dupixent costs significantly depending on the situation.
While having insurance prevents catastrophic costs, high-deductible plans may still leave a patient paying list price out-of-pocket until deductibles are met if Dupixent isn’t on preferred tiers. This effectively makes someone “uninsured” for the year in some cases.
Options vary by location, but some states offer additional programs to aid the uninsured, like limited-benefit Medicaid plans that provide medication assistance. Checking all available public resources is wise.
Financial Hardship Programs
Patients who are genuinely unable to pay may qualify for Sanofi’s financial hardship program, which provides free drug access for up to 12 months, depending on need. This protects the most vulnerable against medical bankruptcy.
FAQs about Dupixent Costs without Insurance
Here are answers to some frequently asked questions:
How Can I Tell if I Qualify for Dupixent Patient Assistance?
Check the program requirements online at the manufacturer’s websites or contact their support lines directly. Qualification is based on household income and insurance status. Provide requested documents to verify financial need during the application process.
What Happens if I Can’t Afford Dupixent without Assistance?
Work closely with your doctor to discuss all available options. Consider appeals if insurance denies coverage. See if alternative treatments may have lower out-of-pocket costs in the short term. As a last resort, inquire about financial assistance, payment plans, or the potential to qualify for local/state aid programs. Don’t delay care altogether due to costs.
How Can I Estimate My Potential Savings with Discounts?
Call the drug manufacturer coupon lines for the most accurate estimates. Know your annual household income and how it relates to federal poverty levels. Also, ask independent pharmacies about potential discounts for cash customers without insurance. Getting quotes lets you budget and plan affordably.
Are There Generic Versions Available Yet?
No, Dupixent currently holds patents and exclusivity that prevent generics. It’s unlikely a biosimilar would enter the market until at least late 2027 based on FDA timelines. Continued high list prices can therefore be expected without insurance until patents expire.
What Should I Do if I’m Denied Coverage Appeals?
If insurance appeals are denied, ask your doctor and hospital for assistance in applying for indigent care programs or negotiating medical bill reductions based on financial hardship. You can also contact independent non-profits that help cover copays/coinsurance or donate medications to low-income patients. As a last resort, create a payment plan with providers to avoid taking on extensive medical debt.