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As many as 50 million people in the U.S. are living with autoimmune conditions, which often involve painful inflammation. For those with psoriatic arthritis, plaque psoriasis, or certain mouth ulcers, the specialty medication Otezla (apremilast) may be a way to find relief.

Otezla was first FDA approved in 2014 for adults with psoriatic arthritis or plaque psoriasis. Later, it was approved to treat adults with Behcet's disease. And, most recently, it's been approved to treat certain children with moderate-to-severe plaque psoriasis who are at least 6 years old.

If your healthcare professional recommends Otezla for you or your child, you should ask about what you can expect to pay and ways to save. The medication can cost upwards of $5,000 a month, but the exact price you'll pay depends on your insurance status, location, and other factors.

Whether you have insurance or not, there are many ways to reduce the cost of Otezla, including signing up for a manufacturer copay savings card or enrolling in a patient assistance program.

How much does a 30-day supply of Otezla cost?

Brand-name Otezla is still protected by patents, so it currently has no price competition from generic versions. That enables Amgen, the manufacturer, to keep the price of Otezla high.

The list price for a 30-day supply of Otezla is currently $4,975. That means that, without manufacturer discounts or insurance, the medication can cost over $59,000 per year.

Otezla has a key advantage over many other psoriasis and psoriatic arthritis medications: It comes in a convenient pill form. Alternative medications for these conditions, such as Humira (adalimumab), must be administered by injection. People typically prefer an oral medication over an injectable, so this may be one reason Otezla is able to command premium pricing.

What factors affect the cost of Otezla?

There are several factors that can affect how much you pay for Otezla, including:

• Pharmacy: Prescription medication prices can differ between pharmacies. This is because pharmacies negotiate their own pricing and can mark up prices as they see fit.

• Location: Where you live can affect how much you pay for prescription medications. For example, according to GoodRx data, people in Little Rock, Arkansas, tend to pay more for prescription medications than people in Denver, Colorado.

• Insurance: If you have insurance that covers Otezla, it can help reduce what you pay for your medication. However, you may still have out-of-pocket expenses such as copays, coinsurance, or a deductible, depending on your health plan. These expenses may be higher if Otezla is listed in a higher tier on your plan's formulary.

• Dosage: Otezla is typically prescribed at a lower starting dosage, which is then adjusted based on treatment needs. A higher dosage could increase your monthly costs.

Is Otezla covered by insurance?

Most health insurance plans - including Medicare, Medicaid, and commercial plans - typically provide some level of coverage for Otezla. Though, you may still have to pay out-of-pocket costs like a deductible, copays, or coinsurance. Your health insurance company may also require a prior authorization before covering the medication.

Does Medicaid cover Otezla?

Medicaid coverage for Otezla varies from state to state, so you'll need to check your plan's formulary for details. For example, Otezla is listed as a preferred agent in Texas and Arizona. Preferred medications are typically covered by state Medicaid programs without a prior authorization, unless there is a specific clinical requirement associated with the medication.

Does Medicare cover Otezla?

Medicare coverage for Otezla varies by plan. Generally, Otezla is covered under Medicare Part D and some Medicare Advantage plans that include prescription medication coverage. If your plan covers Otezla, you may still have out-of-pocket costs such as copays and coinsurance.

4 ways to save on Otezla

Whether you have insurance, are uninsured, or are underinsured, there are ways you can save on your Otezla prescription. Below are four ways to reduce your costs.

1. Use a manufacturer copay savings card

If you have private insurance, you can sign up for Otezla SupportPlus, a copay assistance program from Amgen. If approved, you may be eligible to get Otezla at no cost. The offer is available for up to 12 prescription fills within 12 months. There are no income guidelines but there are other eligibility requirements you may need to meet.

This program is available only to people who have commercial insurance. People insured through Medicare, Medicaid, or another government program are not eligible.

2. Apply for a patient assistance program

If you don't have health insurance or your income is limited, you may qualify to receive Otezla at no cost from the Amgen Safety Net Foundation. You may also qualify for the program if your insurance does not fully cover the cost of Otezla. To apply, visit the program's website and take the following steps:

• Click "How to Apply" in the navigation bar.

• Select "Otezla" from the medication list.

• Download, fill out, and print the application.

• Ask your healthcare professional to fill out your Otezla prescription and fax it to the foundation with the completed application to determine eligibility.

3. Use a mail-order pharmacy

If you have health insurance, you may be able to get discounts on your medication by signing up to receive Otezla through your insurance provider's mail-order pharmacy.

Still, Otezla is a specialty medication that requires unique handling. So expect it to be mailed from a specialty pharmacy. Check with your insurer to find out what savings you can expect if you use the company's mail-order pharmacy for this service.

Some Medicare plans may offer a program that provides you with a 3-month supply of your medication by mail.

4. Use your HSA or FSA

If you have a health savings account (HSA) or flexible spending account (FSA), you can use the funds in your account to purchase prescription medications like Otezla. Since these funds are pr-tax, you can reduce your out-of-pocket expenses through tax savings.

Is there a generic version of Otezla?

There is currently no generic version of Otezla on the market, and there's unlikely to be one until at least 2028.

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