Enhertu (fam-trastuzumab deruxtecan-nxki) is a brand-name intravenous (IV) infusion that’s prescribed for certain types of cancer in adults. The cost of the drug with and without insurance can depend on several factors.
Enhertu is approved by the Food and Drug Administration (FDA) to treat the following types of cancer in adults under certain conditions:
- HER2-positive breast cancer that can’t be removed with surgery or has spread to other parts of the body. HER2-positive cancer cells have a high amount of the protein HER2, which causes the cancer to grow.
- HER2-positive non-small cell lung cancer that can’t be removed with surgery or has spread to other parts of the body.
- HER2-positive cancer of the stomach or area where the stomach and esophagus meet that’s advanced or spread to other parts of the body.
As with all medications, the cost of Enhertu can vary. Factors that may affect the price you’ll pay include:
- your treatment plan
- your insurance coverage
- the cost of the visit to your healthcare professional to receive doses of Enhertu
- whether Enhertu has a savings program (see the “Financial and insurance assistance” section below)
To find out what the cost of Enhertu will be for you, talk with your doctor, pharmacist, or insurance provider. Or look below in the next section to learn how much you can save by using an Optum Perks coupon.
Enhertu contains the active ingredient fam-trastuzumab deruxtecan-nxki, 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.
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 need financial support to pay for Enhertu, or if you need help understanding your insurance coverage, help is available. For example:
- A Patient Savings Program is available for Enhertu. For more information and to find out if you’re eligible for support, call 833-364-3788 or visit the program website.
- A Patient Assistance Program is also available for Enhertu. You can see if you qualify for this program and download a form here.
- 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. A few are listed below:
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 Enhertu.
What is the cost of Enhertu without insurance?
The price you’ll pay for Enhertu if you don’t have insurance can vary based on several factors. But typically, the cost is higher for those without insurance.
There are other factors that could affect what you pay for this drug. These include:
- whether you apply and qualify for any available savings programs
- your dosage
To learn the exact cost you’d pay for this medication without insurance, ask your doctor or pharmacist. You may also want to see if you qualify for any savings programs on Enhertu’s website.
How does Enhertu’s cost compare with that of medications such as Herceptin or Tykerb?
The price you would pay for Enhertu versus that of Herceptin (trastuzumab) or Tykerb (lapatinib) depends on various factors.
For instance, the form of the drug may affect its price. Enhertu and Herceptin are both available as intravenous (IV) infusions. Herceptin also comes in a form called Herceptin Hylecta, which is given by subcutaneous injection. Tykerb comes as an oral tablet. Typically, IV infusions or subcutaneous injections cost more than oral tablets.
There are additional factors that can affect your prescription cost, including:
- the length of your treatment
- whether there are payment assistance programs for your prescribed treatment
- whether you’re paying out of pocket or have insurance
To learn more about the cost of Enhertu compared with other treatments for your condition, talk with your doctor, pharmacist, or insurance provider.
Below is information you may want to consider if you have insurance and receive Enhertu.
Prior authorization: If you have insurance, your insurance company may require prior authorization before it covers Enhertu. This means the company and your doctor will discuss Enhertu in regard to your treatment. The insurance company will then determine whether the medication is covered.
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 Enhertu requires prior authorization.
Type of insurance coverage: Enhertu is given by your doctor or another healthcare professional. If you have insurance, the price of your Enhertu 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 Enhertu doses, 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 Enhertu, you may still have some questions. Talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Enhertu. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you would pay for Enhertu.
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 Enhertu, refer to this article.
- Dosage: Learn about Enhertu and dosage by viewing this article.
- Side effects: For details about Enhertu’s side effects, see this article. You can also look at the Enhertu prescribing information.
- Interactions: You can find out more about what Enhertu interacts with by visiting this article.
- Information about your condition: For more information about your condition, see one of the following hubs:
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.