Cost of Orencia in 2025: Discounts and Resources
In the world of healthcare, the cost of medications can often be a significant concern for patients. This is especially true for specialty biologic drugs like Orencia (abatacept), a brand-name drug prescribed for certain autoimmune conditions.
Orencia is a biologic and belongs to a drug class called selective T cell co-stimulation modulators. As of now, there are no approved biosimilars for Orencia, which contributes to its high cost. A 2017 study estimated the annual cost of Orencia infusion therapy at approximately $46,532 per patient, reflecting its status as a specialty biologic drug without lower-cost biosimilars approved in major markets like the US and Europe.
The cost of Orencia can vary based on factors such as treatment plan, insurance coverage, pharmacy, healthcare professional visit costs, and potential savings programs. Insurance formularies, which categorize drugs as preferred/non-preferred and brand/specialty, also play a role in determining out-of-pocket costs. Orencia, as a specialty biologic, usually has higher costs and may require prior authorization.
If you have insurance, your insurance company may require prior authorization before covering Orencia. Some insurers may also require a documented diagnosis, specialist prescription, and adherence to dosing guidelines before approving coverage, which can affect patient access and cost-sharing.
However, there are ways to save money on Orencia prescriptions. One option is to discuss with your doctor the possibility of alternative therapies that are preferred on your insurance formulary or biosimilars if they become available. Using insurance pharmacy home delivery services may also reduce costs.
Another strategy is to check if your insurance offers any copay assistance or specialty drug programs. While no specific Orencia copay program was mentioned, similar programs exist for other biologics like Enbrel and Humira. You can also ask your healthcare provider to submit prior authorization with clear medical justification to avoid denial and higher costs.
In addition, websites like Medicine Assistance Tool and NeedyMeds provide details about drug assistance programs, ways to make the most of insurance coverage, and links to savings cards and other services. Monitoring developments of abatacept biosimilars could also potentially lower costs once approved.
For more information about rheumatoid arthritis, see our rheumatoid arthritis hub. If you don't have health insurance, talk with your doctor or pharmacist about online pharmacy options that may work for you.
Remember, Orencia On Call offers support for those taking Orencia and can be reached at 800-673-6242 or through the program website. For the exact cost of Orencia for you, talk with your doctor, pharmacist, or insurance provider.
[1] Reference for the cost and biosimilar information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949741/ [2] Reference for insurance formulary information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004905/ [3] Reference for prior authorization and cost-sharing information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042180/ [4] Reference for copay assistance programs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004905/ [5] Reference for other biologics' copay programs: https://www.drugs.com/ppa/enbrel.html, https://www.drugs.com/ppa/humira.html
- Deciders often find the cost of Medicare, including specialty biologic drugs like Orencia, a significant concern, especially for drugs like Orencia with no approved biosimilars.
- Health insurances can impact the cost of health insurance and therapies for patients needing Orencia, as some may require prior authorization and adherence to dosing guidelines before approving coverage.
- Science and advancements, such as the development of biosimilars, could potentially lower the high cost of Orencia in the future.
- Healthcare providers, pharmacists, and insurance providers can offer information about copay assistance programs, home delivery services, and alternative treatments that could help reduce the cost of Orencia prescriptions.
- For those uninsured, online pharmacy options and organizations like Medicine Assistance Tool and NeedyMeds may provide assistance with medication costs and access to other health-and-wellness resources.
