Enbrel is a biologic medication that may be covered by Medicare Part D or Medicare Advantage plans, but costs vary. It doesn’t have a generic version, so it can be more costly. But coupons, discount cards, and assistance programs are available.

Enbrel is a popular specialty biologic medication approved by the Food and Drug Administration (FDA) to treat different types of autoimmune conditions, like rheumatoid arthritis or plaque psoriasis. The medication helps block damage from an overactive immune system.

Generally speaking, Medicare Part B covers biologic drugs that can’t be self-administered, whereas Part D (Medicare Advantage) will pay for those you take or inject yourself.

That said, your specific coverage depends on the exact medication and plan you have. Since Enbrel is considered a specialty drug, you may have a higher copay, depending on your plan.

Let’s take a closer look at how Medicare plans cover Enbrel and what you may have to pay for the medication.

Enbrel is covered by many Medicare Part D plans for self-injection at home. Coverage and costs depend on specific plans based on where you live.

Part D coverage

Part D plans are Medicare-approved private insurance plans that help cover prescription drug costs. If you’re eligible for Original Medicare, you’re eligible for Part D. Original Medicare is made up of Part A (hospital insurance) and Part B (outpatient insurance).

In every state, there are many different plan options to choose from. Premiums, coverage, and out-of-pocket costs vary from plan to plan.

All Part D plans have a formulary. This is a list of covered medications arranged in a tiered format.

Most companies have five or six tiers for their covered medications, with lower cost medications on tiers 1 and 2. Usually, the higher the tier your medication falls under, the more you’ll pay for it.

Medicare requires plans to include at least two medications from each class, like the biologic medications for autoimmune conditions.

Enbrel is categorized as a specialty medication and is in the higher tiers (5 or 6). This means your out-of-pocket costs for it will be on the higher end as well.

It’s important to compare the cost of Enbrel under different Medicare Part D plans and with other medication options. Talk with your doctor about your choices, and use Medicare’s plan comparison tool to find the best options for your needs and budget. Check with your specific plan, as some plans may require you to get prior authorization before covering Enbrel.

Part C (Medicare Advantage) coverage

Medicare Part C, or Medicare Advantage, plans include coverage for the same services as Part A, Part B, and often Part D (prescription drug coverage).

These plans are sold by private insurance companies and are approved by Medicare. Part C plans typically provide additional coverage not included in Original Medicare, like vision, dental, and other wellness benefits.

Some Part C plans may have restrictions on using in-network providers, such as pharmacies and doctors.

Types of plans, coverage, and costs all vary depending on where you live and the amount of coverage you need. Part C does allow you to bundle most of your healthcare needs into one plan.

It’s a good idea to check which plans cover your medications, including Enbrel, and what your cost might be. You can either call the plan provider directly, check with your pharmacy, or use Medicare’s plan finder tool to narrow down specific drug coverage and cost.

Medigap coverage

Medigap, or Medicare supplement insurance, can help you pay for some Original Medicare costs like:

There are 10 plans to choose from depending on where you live.

New Medigap plans no longer offer prescription drug coverage. If you have a plan from before 2006, however, you may still have medication benefits on your plan.

Check with your plan on specific coverage and drug coverage benefits.

Enbrel is a specialty medication in the higher tiers of a drug plan’s formulary, with no generic version available. In addition, since chronic conditions like rheumatoid arthritis and other autoimmune conditions continue throughout your life, medications like Enbrel need to be used long-term for symptom management.

As such, Enbrel is quite costly. The list price for Enbrel is $1,850.46 per weekly 50 milligrams (mg) dose or $7,000 per month.

Fifty mg is the typical recommended dose for adults with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The dose for plaque psoriasis is 50 mg twice weekly for the first 3 months, then 50 mg weekly after that.

As such, cost can be a major consideration in medication choice and continuing therapy for many people with Part D plans. Most Part C and Part D plans have at least two medications in each class, and costs may differ for the covered medications.

Medicare.gov has a tool that can help you estimate your out-of-pocket cost after coverage, depending on your specific plan and where you live.

How do you get Enbrel covered?

You have several ways to save on the cost of Enbrel. You may qualify for:

You can also check whether you qualify for some of the following need-based assistance programs:

Learn more: Enbrel and cost: What you need to know

Was this helpful?

Enbrel is a biologic medication that’s available as an injectable solution for self-administration. It can be used to treat various autoimmune conditions, such as moderate to severe rheumatoid arthritis.

There are no generic versions of Enbrel. If you need help affording Enbrel, there are savings programs for Medicare recipients who qualify based on financial need.

Since autoimmune conditions are chronic and require long-term symptom management, discuss your concerns about medication costs with your doctor. It’s important for your doctor to understand this when making treatment recommendations in order to meet all your needs.