Zulresso is a brand-name medication that contains the active ingredient brexanolone. It is a medication used to treat postpartum depression. The cost will vary depending on several factors, including your insurance plan and the cost to receive the dose from your healthcare provider. The cost for those with insurance will vary depending on factors like your copay and deductible and whether the medication is covered by your insurance. Those without insurance can apply for financial assistance from the manufacturer
How Much Does Zulresso Cost?
Many factors can influence the cost of Zulresso. The type of insurance plan a person carries, or lack thereof, as well as individual factors like an insurance plan’s formulary, can change how much their therapy costs. A drug formulary is a list of prescription medications covered by your health insurance. These formularies vary from plan to plan and may not include certain medications.
If you are paying without insurance, there are ways to save. Patient assistance programs help to cover some or all of the cost of Zulresso, depending on the status of your insurance.1 The cost varies depending on what insurance plan you have, so if you have questions, speak with your insurance provider.
Since Zulresso is given as an infusion by a healthcare provider, it is possible that it will be billed under your medical insurance instead of your prescription insurance. If you have questions about how much Zulresso will cost, talk with your doctor or your insurance provider.
How Much Is Zulresso Without Insurance?
If you don’t have insurance, the price of Zulresso can vary depending on the healthcare facility where you receive the medication and any coupons you qualify for. If you have questions about how much Zulresso will cost without insurance, talk with your doctor.
How Much Does Zulresso Cost With Insurance?
There are different types of insurance options a person can use to cover the cost of their prescriptions. Commercial insurance plans are privately funded through individual policyholders or a group plan funded by an employer. Government plans, like Medicare and Medicaid, are government-sponsored insurance plans funded by the government. The type of plan you have can greatly impact the cost of Zulresso.
Commercial Insurance
Commercial insurance coverage varies with the cost of Zulresso. Each health plan carrier has a variety of health plans to choose from, and each of those has different coverages associated with them. Factors like your specific plan details, copays, premiums, and deductibles affect the cost of your medication. With commercial insurance, you cannot use copay cards, but there are financial assistance programs with Zulresso’s manufacturer that can help you reduce the out-of-pocket costs related to your treatment, up to $15,000 if eligible.2
Medicare
Medicare coverage can impact the cost of Zulresso, although the specifics vary depending on the Medicare plan. Medicare Part D, the prescription drug coverage plan for Medicare, can potentially cover the cost of Zulresso while it is also possible that Zulresso may be billed through Medicare Part B since it is given by a healthcare professional in a clinic or hospital. It is important to note that not all plans may cover the cost of Zulresso or provide significant coverage. To determine the extent of coverage, you would need to talk to your specific Medicare provider or your doctor. Possessing Medicare also precludes an individual from certain financial assistance programs from Zulresso’s manufacturer.
Medicaid
Medicaid is a government-funded healthcare program that provides coverage for low-income individuals. For those who have Medicaid, the cost of Zulresso may be reduced or covered entirely with Medicaid. Those on Medicaid can consider the Free Drug Program available on Zulresso’s website. Under this program, Zulresso can be provided at no cost if eligible.
Zulresso Copay Cards
Copay cards function similarly to coupons, reducing the out-of-pocket cost of medications. Often, the price depends on the medication, strength of the medication, quantity, and where you are filling the prescription. They can be obtained from apps or websites that provide prescription discounts, like GoodRx or WellRx. Those without insurance or who cannot use their insurance often choose to use a copay card to help with costs.
Discount Cards
For Zulresso, copay cards are limited since these medications are not like regular medications you pick up at the pharmacy. They are typically ordered and given by a healthcare professional in a clinic or a hospital.. Otherwise, if you can use a coupon card, then you would obtain one from a discount card website, app, or physical card, which will provide you with a unique set of codes to give to the pharmacy to reduce the cost.3,4
Zulresso Patient Assistance Programs
Patient assistance programs are set up by the drug manufacturer to help patients with the cost of their treatment. To join them, you must meet certain eligibility criteria and follow the instructions to apply for the program. After finding out if you are eligible, you will need to submit the appropriate documents and submit an application. There will be a review of your application where they can either accept or deny your application.
If accepted, you will receive assistance to cover some or all of the cost of Zulresso. Some programs will let you use it in conjunction with your insurance, while others are stricter and do not allow insurance or certain types of insurance options to be used with their program.2
The Zulresso Drug Copay Assistance Program
This program is made to help reduce out-of-pocket copay costs related to Zulresso. If you have commercial insurance, you may be eligible for copay assistance. This program can cover drug-related copay costs up to $15,000, regardless of your income level. Call 844-472-4379 for more information, or visit the financial support page on the Zulresso website linked in the resource list at the bottom of this article.1
Here are examples of the eligibility criteria for the Zulresso Drug Copay Assistance Program:
- Have private, commercial health insurance
- Be prescribed Zulresso for FDA-approved use
- Reside in the United States or US territory
- Be treated by a healthcare professional in the United States or US territory
- Be 15 years of age or older
Zulresso Infusion Copay Assistance Program
The infusion copay assistance program is designed to help reduce out-of-pocket copay costs related to the administration of Zulresso, which is a medication that requires infusion in a healthcare setting for 2.5 days. If you have commercial insurance, you may be eligible for this program to reduce your out-of-pocket infusion-related copay costs up to $2,000, regardless of your income level. Call 844-472-4379 for more information, or visit the financial support page on the Zulresso website linked in the resource list at the bottom of this article.1
Here are examples of the eligibility criteria for the Zulresso Infusion Copay Assistance Program:
- Have private, commercial health insurance
- Be prescribed Zulresso for FDA-approved use
- Reside in the United States or US territory (residents of Massachusetts and Rhode Island are not eligible)
- Be treated by a healthcare professional in the United States or US territory
- Be 15 years of age or older
Zulresso Free Drug Program
This program provides Zulresso at no cost for eligible patients who meet income criteria who otherwise would not be able to access this medication. If you are underinsured or uninsured and meet financial eligibility criteria, you may qualify for this program.
Here are examples of the eligibility criteria for the Zulresso Free Drug Program:
- Be prescribed Zulresso for FDA-approved use
- Reside in the United States or US territory
- Be treated by a healthcare professional in the United States or US territory
- Be 15 years of age or older
- Have a household income less than or equal to 500% of the Federal Poverty Level (FPL)
- Be uninsured or be uninsured under any of the following circumstances: no healthcare insurance, Insured but the insurance does not cover Zulresso, Insured with coverage for Zulresso but ineligible for the Zulresso Copay Assistance Programs, and cannot afford the medication.
How to Get a Zulresso Prescription
To get a prescription for Zulresso, you must consult a licensed physician or psychiatrist. They will assess you to see if you are a good candidate for Zulresso, then prescribe you Zulresso. To use this medication, physicians will work with you to sign up and complete work for an FDA program called REMS, which monitors your safety while on this medication. It should be noted that Zulresso is a medication you can only receive in a certified healthcare facility.
In My Experience
In my experience, medications that are required to be given by qualified medical providers tend to cost more. Insurance companies may not want to cover the medication as well since there are other medications for depression available that are more cost-efficient, although these options do not work the same way as Zulresso and are not specifically for postpartum depression. That is to say, it is impossible to have them cover this medication. Based on past experiences, I think financial assistance through Zulresso’s manufacturer is most likely going to be the best way to keep your costs for this medication down.
Largely, costs depend on your insurance status and what they are willing to cover. You and your physician can work together to talk with your insurance about medication coverage. It is important to talk to your doctor about this topic and follow their guidance. If you are experiencing troublesome thoughts or display symptoms of suicidal ideation, call 911 or visit your nearest emergency room.
