Neulasta® Medicare Coverage

Neulasta®
Chemical name: Pegfilgrastim

Typical dosage: 6mg/0.6ml

Typical type: Injection1

Neulasta® is a medication typically used to prevent chemotherapy-induced neutropenia (low white blood cells) and treat patients exposed to large doses of radiation. It is a brand only medication and is a subcutaneous injection into the fatty part of the skin.

Neulasta is a prescription medication that contains the active ingredient Pegfilgrastim. Neulasta is given once per chemotherapy cycle for prevention of cancer-induced neutropenia, and once weekly for patients who have been exposed to high doses of radiation (called hematopoietic radiation syndrome).

Neulasta stimulates the production, maturation and activation of neutrophils to improve the immune system.

The most common side effects with Neulasta include bone pain, muscle pain and pain in the arms or legs.

Does Medicare cover Neulasta?

Yes! 64% of Medicare Advantage plans and Medicare Part D plans cover Neulasta.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Neulasta.

Find Medicare Advantage plans with drug coverage

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Average costs for Neulasta with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$1,595 – $7,379 $1,463 – $7,166

Additional information

Neutropenia is when your white blood cell count is so low, your body is not able to adequately protect you from infections.

Neulasta is administered by a licensed healthcare provider in a healthcare setting.

Neulasta should be used with caution in patients with sickle cell anemia and may cause a condition called capillary leak syndrome. Capillary leak syndrome may lead to a heartbeat that is not normal, chest pain or pressure, heart attack, lung or breathing problems, bleeding or low blood flow in the stomach or bowel, swelling or feeling confused.

Talk to your doctor about the risks of infant exposure when using Nuelasta during pregnancy or while breastfeeding.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.