Elevidys (delandistrogene moxeparvovec-rokl) and cost

Elevidys cost

As with all medications, the cost of Elevidys can vary. Factors that may affect the price for Elevidys include:

• your child’s treatment plan
• your child’s insurance coverage
• your child’s location
• the cost of the visit to your child’s doctor to receive a dose of Elevidys
• whether Elevidys has a savings program (see the “Financial and insurance assistance” section)

To find out the cost of Elevidys for your child’s treatment, talk with their doctor or insurance provider.

Brand-name vs. biosimilar drugs

Elevidys contains the active ingredient delandistrogene moxeparvovec-rokl, and it’s available only as a brand-name biologic drug. It doesn’t come in a biosimilar version. 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.

Note: The reason “-rokl” appears at the end of the drug’s name is to distinguish it from future biosimilar versions.

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 yearsTrusted Source. 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.

Certain biologic drugs, such as Elevidys, are especially expensive because they’re a type of gene therapy. Gene therapies are generally more expensive to develop and produce than other biologics. They may also be more expensive upfront because they may provide long-term effectiveness and potentially reduce long-term treatment costs.

Financial and insurance assistance

If you need financial support to pay for Elevidys, or if you need help understanding your child’s insurance coverage, help is available. For example:

• A program called SareptAssist is available for Elevidys. For more information and to find out if your child is eligible for support, call 888-SAREPTA (888-727-3782) 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

Learn more about saving money on prescriptions with or without insurance.

Insurance considerations

You may want to consider the following information if you have insurance and your child is prescribed Elevidys.

Prior authorization: If your child has insurance, the insurance company may require prior authorization before it covers Elevidys. This means the company and your child’s doctor will discuss Elevidys in regard to your child’s treatment. The insurance company will then determine whether the medication is covered.

If a drug requires prior authorization but your child starts treatment without prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Elevidys requires prior authorization.

Type of insurance coverage: Elevidys is given by your child’s doctor or another healthcare professional. If you have insurance, the price of your child’s Elevidys 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 your child receives Elevidys doses, such as at a doctor’s office, an infusion clinic, or a hospital.

If you have questions about this process, contact your child’s doctor or insurance provider.

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.