How Much Should I Expect to Pay for ZILBRYSQ® (zilucoplan) Injection?

Prescription drug prices can be confusing. Two people may pay different prices for the same drug, depending on their health plan situation.

ZILBRYSQ is available by prescription as a ready-to-use prefilled syringe that is a once-daily administration. The dose, and by extension the price, depends on how the patient’s weight aligns with the three ZILBRYSQ weight bands and corresponding syringes (16.6 mg, 23.0 mg, and 32.4 mg). The list price¹ of ZILBRYSQ is $1,047 per 23.0 mg syringe², but the amount you pay will largely depend on your prescription drug coverage and will vary based on your weight.

The information below will give you a good idea of what to expect based on your insurance type. For the most accurate information, talk to your insurance provider, as they know the details of your plan.

Please see the full Prescribing Information and Medication Guide for ZILBRYSQ, including the Boxed Warning regarding Serious Meningococcal Infections.

Because of the risk of meningococcal infections, ZILBRYSQ is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). Further information is available at www.ZILBRYSQREMS.com or 1-877-414-8353.

Which Option Below Best Describes Your Health Plan Situation?

I Have Health Insurance Through an Employer or Private Individual Policy

What you pay for ZILBRYSQ will depend on your prescription drug coverage.³ Plans can have different out-of-pocket amounts, and most include an annual deductible. If you haven’t met your deductible, you’ll see higher prices until the deductible is met; then your out-of-pocket cost will likely drop.

I Have Medicare Coverage

If you have enrolled in a Medicare⁴ Advantage Plan or a standalone Part D Plan, your our-of-pocket costs can vary throughout the year depending on which phase of the pharmacy benefit design you are in (for example, deductible, donut hole, etc).

Additionally, there are different limits when receiving care in-network versus out-of-network.

I Have Medicaid Coverage

For most people who have Medicaid coverage, prescription drugs like ZILBRYSQ cost less than $10 per month.⁵ Some states eliminate the copay requirements altogether.

To find out if you qualify for Medicaid, or for more information about copayments in your state, please visit the Medicaid website.

I Don’t Have Insurance or ZILBRYSQ Is Not Covered By My Insurance Plan(6)

For more information, please contact ONWARD at 1-844-669-2731 or visit www.UCBOnward.com. With ONWARD, each patient will be assessed at the individual level to understand their coverage and explain potential financial assistance options that could help.

ONWARD is provided as a service of UCB and is intended to support the appropriate use of UCB medicines. Some program and eligibility restrictions may apply.

References

AnalySource powered by First Data Bank accessed on December 2023. List price is also referred to as wholesale acquisition cost or WAC. WAC is the price at which UCB sells its products to wholesalers.
AnalySource accessed December 2023, based on ZILBRYSQ 23.0 mg (0.574 mL) for patients weighing ≥56 kg to <77 kg.
Based on Commercial Health Plan benefit design (Kaiser Foundation 2022 Employer Health Benefits Survey -- 2022 Employer Health Benefits Survey) and the most common Tier coverage of Specialty Biologics.
‘Medicare Drug Finder’ to determine benefit design for each patient type. Part D cost sharing, or out of pocket (OOP) costs, can depend on eligibility for ‘Extra Help’ (Part D health plan receives a Low-Income Subsidy to manage these patients, enrollment in standard Prescription Drug Program [PDP] or have gap coverage via Medicare Advantage). Average OOP costs are determined based on patient phasing through initial Deductible, Standard OOP, Donut Hole, then catastrophic coverage. https://www.medicare.gov/plan-compare. Accessed December 2023.
Centers for Medicare & Medicaid Services (CMS). Medicaid and CHIP Overview. Maximum Allowable Copayments Determined by Eligible Population’s Household Income. Updated November 2022. **All out-of-pocket charges are based on the specific state’s defined payment amount for that service. Certain groups, including children, terminally ill individuals, and individuals residing in an institution, are exempt from cost sharing. Refer to your state agency for details about Medicaid out-of-pocket costs. https://marketplace.cms.gov/technical-assistance-resources/medicaid-chip-overview.pdf. Accessed December 2023.
Most consumers have some type of health plan coverage that includes a prescription drug benefit. According to recent data, just under 9% of the total U.S. population is uninsured. https://www.kff.org/state-category/health-coverage-uninsured/health-insurance-status. Accessed December 2023.