How much does Breztri cost with Medicare?

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4 days ago

Breztri can cost around $400 without insurance. Medicare drug plans may cover inhalers for COPD, including drugs like Breztri, but specific coverage and cost depend on the exact plan.Breztri Aerosphere is a branded metered-dose inhaler prescribed for treating long-term chronic obstructive pulmonary disease (COPD) in adults. Its active components are budesonide, glycopyrrolate, and formoterol fumarate.Medicare may cover inhaler therapy for COPD with a medication such as Breztri, but no national coverage requirement exists. This means a person's exact coverage depends on the drug and their specific plan.Generally, this coverage falls under Medicare Part D or a Medicare Advantage prescription drug (MAPD) plan. However, if a person needs to use a nebulizer instead of an inhaler, coverage falls under Part B.Glossary of Medicare termsOut-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.Premium: This is the amount of money someone pays each month for Medicare coverage. Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.How much is a 30-day supply of a Breztri inhaler?A 5.8-gram (g) Breztri inhaler costs around $400 without insurance, while a 10.7-g inhaler is about double this price.Whether or not Medicare drug plans cover a Breztri inhaler depends on their formularies, which are lists of covered drugs that differ per plan. If the plan does not cover this drug, it may cover an alternative inhaler.If the plan does cover the drug, how much a person pays out of pocket after coverage depends on the drug's tier classification in the formulary. Generally, the higher the tier, the more a person pays.As of 2025, a person's total out-of-pocket annual expenses on drugs with Medicare have a $2,000 cap.It is also important to remember that private insurers administer Part D and MAPD plans. This means that their deductibles, premiums, and copays vary by plan.In 2025, the national base beneficiary premium for Part D is $36.78, and according to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for Medicare Advantage plans is around $17.Meanwhile, a person using a nebulizer covered by Part B may pay 20% of the cost after they meet their annual deductible of $257, assuming they remain covered by paying their monthly premium of $185.»Learn moreAre COPD inhalers covered by Medicare?Is there a generic drug for Breztri?A generic drug is a precise replica of the active ingredient found in a brand-name medication. Typically, generics are less expensive under Medicare than their brand-name counterparts. This is because Medicare drug plans tend to place them in lower tiers, making them more affordable. However, Breztri Aerosphere is exclusively available as a brand-name product and does not have a generic alternative.Because Breztri may be more costly, a person's drug plan may ask them to undergo prior authorization before approving coverage. This process may include step therapy, which is when a person tries an alternative, similarly effective, and less costly medication first.»Learn more:Breztri Aerosphere and costAre people with Medicare coverage eligible for $35 inhalers?Starting in June 2024, some pharmaceutical companies implemented a monthly spending limit of $35 for inhalers. This limit applies to people regardless of whether they have private insurance.However, those with government-funded health insurance, like Medicare or Medicaid, do not qualify for the $35 inhaler price.The manufacturer of Breztri, AstraZeneca, offers a separate cost assistance program for Medicare beneficiaries who still need help paying for certain drugs. To see whether they qualify, a person can visit the manufacturer's website.TakeawayBreztri Aerosphere is a brand-name inhaler used to manage COPD in adults in the long term. While Medicare drug plans might provide coverage for COPD inhaler treatments like Breztri, there is no universal mandate for them. This means that a person's specific coverage varies based on the medication and their particular plan.Typically, this coverage is available for Medicare Part D or a Medicare Advantage prescription drug (MAPD) plan. However, if someone requires a nebulizer instead of an inhaler, coverage falls under Part B. The specific plan determines the exact coverage and costs.Medicare resourcesFor more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.