Medicare Advantage Drug Cost for Enbrel
There are 45 Medicare Advantage Plans with additional prescription drug coverage for Enbrel available to residents in Connecticut. The average retail unit cost (e.g. per pill) for a 30-day supply at in-area retail pharmacies is $838.03 ($25,140.94). Enbrel is typically listed as a Tier 5 drug on the formulary and does not require prior authorization.
Below is the average retail cost and your co-pay for Enbrel in Connecticut. You can also see if each plan requires prior authorization, step therapy or has drug quantity limits. Please check the formulary for different brand and generic drug names. Every Medicare Advantage Plan will vary in coverage, co-pays, costs and premiums. This chart can help you sort through different plan details to find a Medicare Advantage Plan in Hartford with the best coverage and the cheapest prices for your medications in Connecticut.
| Proprietary Name: | Enbrel |
|---|---|
| Generic Name: | Etanercept |
| Drug Package: | 4 Kit In 1 Carton |
| Drug Strength: | |
| Substance: | |
| Dosage Form: | Kit |
| Route: | |
| Labeler: | Immunex Corporation |
| Pen Name: | Human Prescription Drug |
| NDC# | 58406042534 |
| RX# | 261105 |
| Days Supply: | 30 |
| Coverage Phase: | Initial Coverage |
| Plan Year: | 2023 |
| County: | Hartford |
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Medicare Advantage Coverage for Enbrel in Connecticut
Click the Plan Name for More Details
Click the header to sort
| Plan Name ⇅ |
Tier Level |
Your Cost Preferred |
Cost Non Preferred |
Cost |
Limit Amt/ Days |
Prior Auth Y/N |
Step Therapy Y/N |
Avg Unit Cost (x30) |
|---|---|---|---|---|---|---|---|---|
| AARP Medicare Advantage Choice |
5 | NA | 33% | 33% | / | Y | N | $825.24 ($24,757.12) |
| AARP Medicare Advantage Choice |
5 | NA | 28% | 28% | / | Y | N | $854.39 ($25,631.73) |
| Aetna Medicare Elite Plan |
5 | 33% | 33% | 33% | / | Y | N | $865.32 ($25,959.69) |
| Aetna Medicare Elite Plan |
5 | 33% | 33% | 33% | / | Y | N | $865.32 ($25,959.69) |
| Aetna Medicare Essential Elite Plan |
5 | 33% | 33% | 33% | / | Y | N | $865.32 ($25,959.69) |
| Aetna Medicare Explorer Premier Plan |
5 | 29% | 29% | 29% | / | Y | N | $865.32 ($25,959.69) |
| Aetna Medicare Value Plan |
5 | 33% | 33% | 33% | / | Y | N | $865.32 ($25,959.69) |
| Anthem MediBlue Access Select |
5 | 31% | 31% | NA | / | Y | N | $865.99 ($25,979.66) |
| Anthem MediBlue Extra |
5 | 25% | 25% | NA | / | Y | N | $865.99 ($25,979.66) |
| Anthem MediBlue Plus |
5 | 25% | 25% | NA | / | Y | N | $875.25 ($26,257.44) |
| Anthem MediBlue Select |
5 | 28% | 28% | NA | / | Y | N | $867.78 ($26,033.27) |
| CarePartners Access |
5 | 33% | 33% | NA | / | Y | N | $811.96 ($24,358.84) |
| CarePartners of CT CareAdvantage Preferred |
5 | 33% | 33% | NA | / | Y | N | $811.96 ($24,358.84) |
| CarePartners of CT CareAdvantage Prime |
5 | 33% | 33% | NA | / | Y | N | $811.96 ($24,358.84) |
| ConnectiCare Choice Plan 1 |
5 | 27% | 27% | 27% | / | Y | N | $788.00 ($23,639.93) |
| ConnectiCare Choice Plan 3 |
5 | 33% | 33% | 33% | / | Y | N | $788.00 ($23,639.93) |
| ConnectiCare Flex Plan 1 |
5 | 27% | 27% | 27% | / | Y | N | $788.00 ($23,639.93) |
| ConnectiCare Flex Plan 2 |
5 | 27% | 27% | 27% | / | Y | N | $788.00 ($23,639.93) |
| ConnectiCare Flex Plan 3 |
5 | 27% | 27% | 27% | / | Y | N | $789.10 ($23,672.99) |
| ConnectiCare Passage Plan 1 |
5 | 30% | 30% | 30% | / | Y | N | $788.00 ($23,639.93) |
| HumanaChoice H5216-288 |
5 | NA | 28% | 28% | / | Y | N | $865.32 ($25,959.69) |
| HumanaChoice H5216-289 |
5 | NA | 28% | 28% | / | Y | N | $865.32 ($25,959.69) |
| UnitedHealthcare Medicare Advantage Plan 1 |
5 | NA | 33% | 33% | / | Y | N | $853.30 ($25,599.14) |
| UnitedHealthcare Medicare Advantage Plan 2 |
5 | NA | 33% | 33% | / | Y | N | $853.30 ($25,599.14) |
| UnitedHealthcare Medicare Advantage Plan 3 |
5 | NA | 33% | 33% | / | Y | N | $853.30 ($25,599.14) |
| Wellcare Assist |
5 | 25% | 25% | 25% | / | Y | N | $846.09 ($25,382.81) |
| Wellcare Assist Open |
5 | 25% | 25% | 25% | / | Y | N | $846.09 ($25,382.81) |
| Wellcare Giveback Open |
5 | 26% | 26% | 26% | / | Y | N | $847.13 ($25,413.87) |
| Wellcare No Premium |
5 | 29% | 29% | 29% | / | Y | N | $847.13 ($25,413.87) |
| Wellcare No Premium Open |
5 | 29% | 29% | 29% | / | Y | N | $847.13 ($25,413.87) |
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SNP Prescription Drug Cost for Enbrel
Click the header to sort
| Plan Name ⇅ |
Tier Level |
Cost Preferred |
Cost Non Preferred |
Cost Amt |
Limit Days/ Amt |
Prior Auth Y/N |
Step Therapy Y/N |
Avg Unit Cost (x30) |
|---|---|---|---|---|---|---|---|---|
| Aetna Medicare Assure Plan |
5 | NA | $0 | NA | / | Y | N | $865.32 ($25,959.69) |
| Anthem MediBlue Care To You |
5 | NA | 33% | NA | / | Y | N | $769.56 ($23,086.71) |
| Anthem MediBlue Dual Access |
5 | 25% | 25% | NA | / | Y | N | $865.99 ($25,979.66) |
| Anthem MediBlue Dual Advantage |
5 | 25% | 25% | NA | / | Y | N | $865.99 ($25,979.66) |
| Anthem MediBlue Dual Advantage Select |
5 | 25% | 25% | NA | / | Y | N | $865.99 ($25,979.66) |
| Anthem MediBlue ESRD Care |
5 | 28% | 28% | NA | / | Y | N | $867.78 ($26,033.27) |
| ConnectiCare Choice Dual |
5 | NA | 25% | NA | / | Y | N | $788.00 ($23,639.93) |
| ConnectiCare Choice Dual Basic |
5 | NA | 25% | NA | / | Y | N | $788.00 ($23,639.93) |
| ConnectiCare Choice Dual Vista |
5 | NA | 25% | NA | / | Y | N | $788.00 ($23,639.93) |
| HumanaChoice SNP-DE H5216-290 |
5 | NA | $0 | NA | / | Y | N | $865.32 ($25,959.69) |
| UnitedHealthcare Assisted Living Plan |
5 | NA | 33% | 33% | / | Y | N | $857.89 ($25,736.59) |
| UnitedHealthcare Dual Complete |
5 | NA | $0 | NA | / | Y | N | $853.30 ($25,599.14) |
| UnitedHealthcare Nursing Home Plan |
5 | NA | 25% | NA | / | Y | N | $854.45 ($25,633.46) |
| Wellcare Dual Access |
1 | NA | $0 | NA | / | Y | N | $846.09 ($25,382.81) |
| Wellcare Dual Liberty |
1 | NA | $0 | NA | / | Y | N | $846.09 ($25,382.81) |
Do any Medicare Advantage Plans Cover Enbrel? Yes, 45 Medicare Advantage Plans cover this drug in Connecticut.
How much does Enbrel Cost? $838.03, the average retail cost in Connecticut is $838.03 per unit or $25,140.94 for a 30-day supply at in-area pharmacies.
What Tier is Enbrel? Tier 5, most Advantage Plans list Enbrel on Tier 5 on their formulary. Usually, the higher the tier, the more you have to pay for the medication.
Do I need Prior Authorization for Enbrel? Yes, the majority of Medicare Prescription Plans do require prior authorization from your doctor for Enbrel.
Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1.Pre-Deductable: Before you reach the plans deductible. Some plans offer select Pre-deductible drug Coverage
2.Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit.
3.Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7550 in 2022.
4.Catastrophic: Anything over $7550 you will receive a significant increase in coverage.
Formulary Definitions:
Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Cost Preferred: Your Cost for the Drug at the Providers In Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non Preferred: Your Cost for the Prescription Drug at a Non-Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization in order to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Avg Unit Cost: Average unit cost (e.g. per pill) for specified days supply at in-area retail pharmacies. A pharmacy is considered in-area when it is geographically located in the service area.
What if a drug I need is not listed?
Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plans formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.
Last updated on
Source:CMS Formulary Data Q4 2022
Source:NDC Directory by FDA.gov
**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.