Simponi and cost

As with all medications, the cost of Simponi and Simponi Aria can vary. Factors that may affect the price you’ll pay include:

• your treatment plan
• your insurance coverage
• the pharmacy you use
• the cost of the visit to your doctor to receive doses of Simponi Aria or, if needed, Simponi
• whether Simponi or Simponi Aria has a savings program (see the “Financial and insurance assistance” section below)

To find out what the cost of Simponi or Simponi Aria will be for you, talk with your doctor, pharmacist, or insurance provider.

Simponi and Simponi Aria both contain the active ingredient golimumab. These medications are available only as brand-name biologic drugs. They don’t come in biosimilar versions at this time. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Also, biosimilars tend to cost less than brand-name medications.

WHY ARE COSTS DIFFERENT FOR BIOLOGIC DRUGS VS. BIOSIMILAR DRUGS?

Biologic drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to 12 years. When the biologic drug’s patent expires, multiple manufacturers can create biosimilar versions. This marketplace competition may lead to lower costs for biosimilars. Also, because biosimilars are very similar to biologic drugs, they don’t require the same costly testing.

If you take Simponi long term, you may be able to lower its cost in the following ways.

Getting a 3-month supply

You may be able to get a 90-day supply of Simponi. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost. If you’re interested in this option, check with your doctor, pharmacist, or insurance provider.

Using a mail-order pharmacy

Simponi may be available through a mail-order pharmacy. Using this type of service may help lower the drug’s cost and allow you to receive your medication without leaving home. Some Medicare plans may help cover the cost of mail-order medications. You may also be able to get a 90-day supply of the drug via mail order.

If you don’t have health insurance, talk with your doctor or pharmacist. They may be able to suggest online pharmacy options that could work for you.

Note: If your doctor prescribes Simponi Aria, you’ll receive your doses in your doctor‘s office, hospital, or clinic. In this case, you likely won’t be able to get a 3-month supply or use a mail-order pharmacy for savings options. If you have questions about this, talk with your doctor for more information.

If you need financial support to pay for Simponi or Simponi Aria, or if you need help understanding your insurance coverage, help is available. For example:

• A program called Janssen CarePath is available for Simponi and Simponi Aria. For more information and to find out whether you’re eligible for support, call 877-227-3728 or visit the program website.
• Some websites provide details about drug assistance programs, ways to make the most of your insurance coverage, and links to savings cards and other services. Two such websites are:
  • Medicine Assistance Tool
  • NeedyMeds

To learn more about saving money on prescriptions with or without insurance, check out this article.

Here are answers to some frequently asked questions about drug cost and Simponi.

What is the cost of Simponi without insurance?

The price you’ll pay for Simponi or Simponi Aria if you don’t have insurance can vary based on several factors. But typically, the cost is higher without insurance.

There are many factors that could affect what you pay for this drug. These include:

• the quantity you’re prescribed (such as a 90-day or 30-day supply)
• whether you apply and qualify for any available savings programs
• your dosage
• the pharmacy you use
• the drug and form you’re prescribed
• your cost of receiving your dose of Simponi Aria or Simponi (if you don’t self-inject)

To learn the exact cost you’d pay for this medication without insurance, ask your doctor or pharmacist. You may also want to contact several pharmacies to compare their prices for Simponi.

Is Simponi covered by Medicare?

It may be. There are many types of Medicare plans, so your coverage and what you pay for prescriptions will be based on your particular plan’s benefits. You can call your Medicare plan provider to learn whether your particular plan covers the cost of this drug.

The total price you pay for Simponi or Simponi Aria may also depend on the cost of receiving your injections. And you may need prior authorization before your Medicare plan will cover the cost of this medication. (For details, see “Insurance considerations” just below.)

Your doctor may be able to provide information about your cost for Simponi or Simponi Aria if you have Medicare.

Below is information you may want to consider if you have insurance and receive Simponi.

Prior authorization: If you have insurance, your insurance company may require prior authorization before it covers Simponi or Simponi Aria. This means the company and your doctor will discuss Simponi in regard to your treatment. The insurance company will then determine whether the medication is covered.

In some cases, it’s possible for your insurance company to prefer one version of the drug or another. For example, some insurance companies may prefer that you use Simponi Aria (the IV infusion). Other companies may prefer that you use Simponi (the subcutaneous injection).

If a drug requires prior authorization but you start treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Simponi or Simponi Aria requires prior authorization.

Type of insurance coverage: Simponi Aria is always given by your doctor or another healthcare professional. If you have insurance, the price of your doses may be billed through your medical coverage instead of the prescription drug portion of your insurance plan. This depends on your specific insurance plan and where you receive your Simponi Aria infusions, such as at your doctor’s office, an infusion clinic, or a hospital. If you have questions about this process, contact your doctor or your insurance provider.

Now that you’ve learned about cost and Simponi, you may still have some questions. Talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Simponi. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you’d pay for Simponi.

Here are some other resources you may find helpful:

• Medicare drug coverage: To learn about Medicare coverage for drugs, see these articles about Medicare prescription drug plans, drug coupons and Medicare, and the Medicare drug list.
• More details: For details about other aspects of Simponi, refer to this article.
• Dosage: Learn about Simponi and dosage by viewing this article.
• Side effects: For details about Simponi’s side effects, see this article. You can also look at the prescribing information for Simponi and Simponi Aria.
• Information about your condition: For more information about some of Simponi’s approved uses, see our rheumatoid arthritis hub and articles about:
  • psoriatic arthritis
  • ulcerative colitis

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.