Does Medicare Cover Fasenra?

Does Medicare cover Fasenra? People who have eosinophilic asthma usually add Fasenra to their regimen with other medications to help control this disease. Any asthma patient who is at least 12 years old or older who have a diagnosis of eosinophilic asthma may experience fewer severe asthma attacks and improve their symptoms while they use this drug. But, does Medicare insurance help to pay for the costs?

Medicare Benefits Solutions

Jun 20, 2021

 4 minutes read

Understanding Eosinophilic Asthma

There is a decent percentage of asthma patients that have eosinophilic asthma, and doctors can diagnose the eosinophilic phenotype by using a blood test. The blood test will reveal that the person has a high eosinophil count, and this is a type of white blood cell. Eosinophils are a part of your immune system, and they help your body fight infections or disease. However, dander, dust, viruses, pollen, or mold can trigger them. In turn, this causes worsening asthma symptoms. It can result in inflammation, swelling, or excess mucus production in the bronchial airways and lungs. 

Anyone who has these signs or symptoms could get a blood test that could confirm if they have eosinophilic asthma. The biggest indicators are having two or more severe attacks in a calendar year, high levels of eosinophils, and responding to systemic corticosteroid treatments. 

Other indicators including using a rescue inhaler on a frequent basis to control your symptoms, requiring urgent care or emergency room care to help manage your symptoms, or waking up from your sleep at night with your symptoms getting worse. 

How Fasenra Works

When your body has an inflammatory response, it will produce a substance called Interleukin-5, or IL-5. This substance will bind itself to eosinophil cells’ receptors and cause them to activate. This activation process boosts their survival time, and this can help them live longer. However, this can also result in excess Interleukin-5 cells in your body. 

Fasenra uses an approach to help your body eliminate any excess eosinophils floating around. This medication has the distinction of being the only anti-eosinophilic antibody that will directly bind itself to the IL-5 receptor, alpha. This medication draws the killer cells in to induce cell death, and it does all of this without discharging any inflammatory mediators. 

Your doctor will administer the first three doses of this medication in 30-milligram increments at four-week intervals. They’ll then give you subsequent doses once every eight weeks using a subcutaneous injection into your abdomen, upper arm, or thigh. Your doctor will administer your medication in a clinic or outpatient setting. 

This medication can potentially cut the number of severe asthma attacks you have in a year by half. It can also improve your overall lung function, and this can help you breathe easier. It can reduce the number of oral steroids you take, and it can increase your overall quality of life from the first dose. 

Does Medicare cover Fasenra?

Unfortunately, this medication isn’t cheap. A single 30-milligram dose of this drug can cost $4,895. How much you pay will depend on your specific Medicare coverage. If you have Original Medicare, Part B will cover 80% of the Medicare-approved costs while you pay 20%. Your facility and doctor have to accept Medicare assignment. A Medicare Supplement plan can help you pay for the remaining 20% of the cost if you have purchased a Medigap policy. 

If you currently have a Medicare Advantage plan for your Medicare insurance, you’ll get at least the same coverage amount as you would get under Original Medicare. However, Medicare Advantage plans can include additional coverage that eliminates the need for supplemental insurance. You should check with your specific insurance provider before you decide to use this drug, and this will help you understand the total cost.

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