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Is Veozah Covered by Insurance?

Key Takeaways

  • Insurance coverage for Veozah varies by insurance plan, insurance provider, and whether prior authorization is required.
  • Many commercial health insurance plans may cover Veozah for severe vasomotor symptoms of menopause, but coverage is not guaranteed.
  • Medicare and Medicaid coverage can differ by state, formulary placement, and eligibility requirements.
  • Out-of-pocket costs may be reduced through the Veozah Savings Program or Astellas patient assistance programs for eligible patients.
  • A healthcare provider can help determine coverage and submit the required documentation.

What Is Veozah?

Veozah is the brand-name prescription drug fezolinetant, approved by the Food and Drug Administration (FDA) for the treatment of moderate to severe vasomotor symptoms of menopause. These symptoms, often called VMS, include hot flashes and night sweats that significantly affect quality of life.

Veozah is a non-hormonal treatment option and does not contain estrogen or progesterone. Instead, it works as a neurokinin 3 receptor antagonist, targeting temperature regulation pathways in the brain. Because it is not hormone therapy, Veozah may be prescribed for women who cannot or prefer not to use hormone replacement therapy.

Is Veozah Typically Covered by Insurance?

Veozah may be covered by insurance, but coverage is not automatic. Because it is a newer, brand-name prescription drug, insurance coverage often depends on the specific health plan and how the medication is listed on the plan’s formulary.

Some insurance plans classify Veozah as a preferred or non-preferred brand-name drug, which affects copay amounts. Others may require additional steps before approving coverage, even with a valid prescription.

Coverage is more likely when:

  • Veozah is prescribed for severe vasomotor symptoms.
  • Your menopause symptoms have not responded to alternative treatments.
  • Documentation supports medical necessity.

Prior Authorization Requirements

Some insurance plans may require prior authorization for Veozah. Prior authorization means the insurance company must approve the medication before it will be covered.

During this process, the healthcare provider submits information explaining:

  • The severity of vasomotor symptoms.
  • Previous treatments tried, including hormone therapy or other interventions.
  • Contraindications to estrogen-based therapies, if applicable.

Without prior authorization, insurance plans may deny coverage or require the patient to pay the full out-of-pocket cost.

Veozah and Commercial Health Insurance

Commercial health insurance plans often cover Veozah, but cost-sharing varies widely. Some patients may have a low copay for a 30-day supply, while others may face higher out-of-pocket costs depending on their deductible status and formulary tier.

Insurance coverage can change within a calendar year, so coverage at one refill does not guarantee the same cost at the next refill. Patients are encouraged to verify coverage directly with their insurance provider or pharmacy.

Is Veozah Covered by Medicare?

Medicare coverage for Veozah depends on the specific Medicare Part D plan. Not all Medicare plans include Veozah on their formularies, and some may place it on a higher tier with higher copays.

Even when covered, Medicare plans may require:

  • Prior authorization
  • Step therapy
  • Higher out-of-pocket costs

Because Medicare is a form of government insurance, patients enrolled in Medicare are generally not eligible for manufacturer copay cards but may qualify for other savings options or patient assistance programs.

Out-of-Pocket Costs Without Insurance

Without insurance coverage, Veozah can be expensive. As a brand-name medication, its retail price for a 30-day supply may result in high out-of-pocket costs.

Your cost will depend on the pharmacy you are using and the availability of any savings options or coupons. Patients paying out-of-pocket are encouraged to explore manufacturer programs before filling a prescription.

Veozah Savings Program and Patient Assistance

Astellas Pharma US offers support programs to help eligible patients reduce costs.

Veozah Savings Card

The Veozah Savings Card may lower copay costs for patients with commercial insurance who meet eligibility requirements. The savings card typically cannot be used with Medicare, Medicaid, or other government insurance.

Astellas Patient Assistance Program

The Astellas patient assistance program may provide Veozah at low or no cost for eligible patients who are uninsured or underinsured. Income limits and other criteria apply.

Patients can enroll or request additional information through Veozah Support Solutions or the Astellas Pharma US website.

What You Can Do to Check Coverage

To determine whether Veozah is covered by your insurance plan:

  1. Ask a healthcare professional if prior authorization is required.
  2. Contact your insurance company directly and ask about formulary placement.
  3. Check whether step therapy or other documentation is needed.
  4. Ask your pharmacy for an estimate of copay or out-of-pocket cost.
  5. Explore savings options and assistance programs.

Being proactive can help prevent delays in starting treatment.

When to Talk to a Healthcare Provider

Talk to a healthcare provider:

  • Your hot flashes or night sweats significantly affect your daily life.
  • You want to explore non-hormonal menopause treatment options.
  • You are unsure whether Veozah is covered by your health plan.
  • You need help with prior authorization or enrollment in savings programs.

A healthcare professional can help navigate insurance coverage and treatment decisions.

Bottom Line

Veozah may be covered by insurance, but it depends on your insurance plan, formulary status, and whether prior authorization is required. Commercial insurance plans are more likely to cover Veozah than government insurance, though Medicare and Medicaid coverage are possible in some cases. For patients facing high out-of-pocket costs, savings programs and patient assistance options through Astellas may help reduce expenses.

FAQs

Is Veozah covered by insurance?
Coverage varies by insurance plan. Many commercial plans cover Veozah with prior authorization.

Does Medicare cover Veozah?
Some Medicare Part D plans may cover Veozah, but coverage and copays vary.

Can I use a savings card with Medicare or Medicaid?
No. Savings cards are usually limited to patients with commercial insurance.

How do I lower my out-of-pocket cost?
Check eligibility for the Veozah Savings Program or the Astellas patient assistance program.

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