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Is Dupixent Covered By Insurance? What to Know

Dupixent is used to treat conditions like eczema, asthma, and nasal polyps. It can be an important medicine, but it can also be expensive. Knowing whether your insurance covers it can help you plan for your healthcare costs. This article will help you understand Dupixent coverage and what options you have if your insurance doesn’t fully pay for it.

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In This Article

What is Dupixent Used For?

Dupixent (dupilumab) is a prescription medicine called a biologic. Biologics are made from living cells. Dupixent is used to treat several conditions:

  • Eczema (atopic dermatitis): This condition causes itchy, inflamed skin. Dupixent can help reduce itching and skin rashes.
  • Asthma: Dupixent can help people with moderate-to-severe asthma by reducing the number of asthma attacks.
  • Nasal polyps: These are growths in the nose that can make it hard to breathe. Dupixent can help shrink these polyps.

How Do I Check if My Insurance Covers Dupixent?

The best way to find out if your insurance covers Dupixent is to contact your insurance company directly. Here’s how:

  • Call your insurance provider: The phone number is usually on your insurance card. Ask them if Dupixent (dupilumab) is on their list of covered drugs (called a formulary).
  • Check your insurance plan’s website: Most insurance companies have websites where you can log in and check your plan details. Look for a section on covered medications or a formulary search tool.

When you contact your insurance company, be ready to provide the name of the medicine (Dupixent) and the condition it treats. They may also ask for the drug code or National Drug Code (NDC).

What Factors Affect Dupixent Coverage?

Several factors can affect whether your insurance covers Dupixent:

  • Formulary: Each insurance plan has a list of covered drugs, called a formulary. If Dupixent is on the formulary, it is more likely to be covered. However, even if it is on the list, there may be other requirements.
  • Prior authorization: Many insurance companies require prior authorization before they will cover Dupixent. This means your doctor needs to get approval from the insurance company before you can start taking the medicine. They want to make sure it is medically necessary for you.
  • Step therapy: Some insurance plans require you to try other, less expensive medicines first before they will cover Dupixent. This is called step therapy. If those medicines don’t work, they may then approve Dupixent.
  • Medical necessity: The insurance company will want to make sure that Dupixent is medically necessary for your condition. Your doctor will need to provide information to support this.

What If My Insurance Doesn’t Cover Dupixent?

If your insurance doesn’t cover Dupixent, you have several options:

  • Appeal the decision: You can ask your insurance company to reconsider their decision. Your doctor can help you with this by providing more information about why you need Dupixent.
  • Look for patient assistance programs: The manufacturer of Dupixent, Sanofi, has a patient assistance program called Dupixent MyWay. This program helps eligible patients with the cost of Dupixent. They may offer financial help or connect you with other resources.
  • Consider other insurance plans: If your insurance doesn’t cover Dupixent, you might want to look into other insurance plans that do. This could mean changing to a different plan through your employer or buying a plan on the health insurance marketplace.
  • Pay out-of-pocket: You can pay for Dupixent yourself without insurance. However, this can be very expensive. The cost of Dupixent can vary, but it is often several thousand dollars per dose. If you choose this option, explore options through Universal Drugstore that may be more affordable.

Are There Programs to Help with the Cost of Dupixent?

Yes, some programs can help with the cost of Dupixent:

  • Dupixent MyWay: This program offers several types of support, including a copay card. If you are eligible, this card can help lower your out-of-pocket costs. They also offer personalized support to help you understand your insurance coverage and navigate the process of getting Dupixent.
  • Patient assistance programs: Sanofi may also offer patient assistance programs for people who meet certain income requirements. These programs can provide Dupixent at a reduced cost or for free.
  • Non-profit organizations: Some non-profit organizations help people afford their medicines. Check with organizations focused on eczema, asthma, or nasal polyps to see if they offer any financial assistance programs.

Understanding Dupixent Costs

The cost of Dupixent can be a concern for many people. Without insurance, Dupixent can be very expensive. Even with insurance, you may have high copays or deductible costs.

If you’re looking to manage prescription costs, comparing prices and exploring options like Universal Drugstore can provide significant savings. It’s also worth discussing potential alternatives or generics with your healthcare provider.

Common Side Effects

Like all medicines, Dupixent can cause side effects. Here are some of the more common side effects:

  • Injection site reactions (redness, swelling, itching at the injection site)
  • Eye problems, such as conjunctivitis (pink eye)
  • Cold sores
  • High count of a certain white blood cell (eosinophilia)
  • Joint pain

Serious but Rare Side Effects

Serious side effects from Dupixent are rare. However, if you experience any of the following, seek medical attention right away:

  • Allergic reactions (rash, hives, itching, trouble breathing)
  • New or worsening eye problems (vision changes, eye pain)
  • Joint pain

This is not a complete list of side effects. Talk to your doctor if you have any concerns.

Understanding insurance coverage for medications like Dupixent can be complex. Here are a few tips to help you navigate the process:

  • Know your plan: Take the time to read and understand your insurance plan’s details. Pay attention to the formulary, prior authorization requirements, and step therapy policies.
  • Keep good records: Keep track of all communications with your insurance company, including dates, names, and details of the conversation.
  • Advocate for yourself: Don’t be afraid to ask questions and challenge decisions if you don’t agree with them. Enlist the help of your doctor and patient advocacy groups.

By understanding your insurance coverage and exploring all available options, you can work with your healthcare provider to get the medicine you need at a price you can afford.

If you have any other questions, check out our frequently asked questions page.

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