Does Medicare Cover Verzenio? 

Today in the United States, breast cancer is the second most common type of cancer for women. In fact, it’s estimated that over 297,000 new cases will be diagnosed before the year ends. 

The National Cancer Institute reports that women who are 70 years and older have a one in 24 chance of developing breast cancer at some time in their lives, and approximately 45 percent of newly diagnosed cases of breast cancer occur in women over age 65.  

Fortunately, there are many effective treatments for breast cancer available today, and the five-year survival rate is at 90 percent, while the 10-year survival rate is around 84 percent.  

In 2017, the U.S. Food and Drug Administration (FDA) approved the brand name drug Verzenio for use in treating advanced or metastatic breast cancer. The generic form of the drug, abemaciclib, works by inhibiting CDK. CDK4 and CDK6 inhibitors are types of medications that block the internal process that causes breast cancer cells to divide and multiply.  

If your physician prescribes Verzenio, you may have Medicare coverage for this drug. 

Does Medicare cover prescriptions of Verzenio?

To get coverage for prescription drugs like Verzenio, you must enroll in either a stand-alone Medicare Part D plan or a Medicare Advantage (Part C) plan that includes prescription drug benefits. 

Medicare prescription drug plans are sold by private insurance companies that work with Medicare. You pay a monthly premium, deductible, and copayments for your prescriptions. The amount you pay depends on the type of Part D plan you have, on which tier your plan has categorized your prescription drug, and which coverage stage you’re in. 

Today, most Medicare prescription drug (Part D) plans cover the brand-name prescription drug Verzenio as well as the generic form. Most Medicare prescription drug plans that cover Verzenio have it listed on tier five because it’s a specialty drug, and tier-five drugs typically carry the highest coinsurance amount. 

Depending on the type of Part D coverage you have, your plan may require that you purchase your prescription of Verzenio from a pharmacy that carries specialty drugs. Your plan provider should provide you with this information on your policy, but if you aren’t sure, you can contact them for assistance. 

How much does a prescription of Verzenio cost without Medicare insurance coverage? 

If you don’t have Medicare prescription drug coverage, your out-of-pocket cost for Verzenio can vary according to your treatment plan, the strength of the tablets, and where you purchase the drug. 

Today in the United States, the national average cost of a one-month supply of Verzenio is approximately $13,000, or about $3,835 for a supply of 14 tablets of 50 mg each.