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Does Insurance Cover Vascepa's Higher Cost?

Understanding the High Cost of Vascepa

Vascepa, a prescription medication used to treat high triglycerides, has gained popularity in recent years due to its effectiveness in reducing triglyceride levels. However, its high cost has become a major concern for many patients and healthcare providers. The question on everyone's mind is: does insurance cover Vascepa's higher cost?

What is Vascepa?

Vascepa is a prescription medication containing omega-3 fatty acids, specifically EPA (eicosapentaenoic acid). It is used to treat high triglycerides, a condition characterized by elevated levels of triglycerides in the blood. High triglycerides can increase the risk of heart disease, pancreatitis, and other health problems.

How Does Vascepa Work?

Vascepa works by reducing triglyceride levels by inhibiting the production of triglycerides in the liver. It also has anti-inflammatory properties, which can help reduce inflammation in the body.

The High Cost of Vascepa

Vascepa is a relatively new medication, and its high cost is attributed to several factors, including:

* Patent protection: Vascepa's patent protection has limited competition, allowing the manufacturer to set a higher price.
* Research and development: The development of Vascepa required significant investment in research and clinical trials.
* Marketing and advertising: The manufacturer has invested heavily in marketing and advertising campaigns to promote the medication.

The Cost of Vascepa

The cost of Vascepa varies depending on the dosage and quantity. According to DrugPatentWatch.com, the average wholesale price (AWP) of Vascepa is around $250 per 1,000mg capsule. This means that a 30-day supply of Vascepa can cost around $750 to $1,500.

Does Insurance Cover Vascepa's Higher Cost?

The answer to this question is not straightforward. Insurance coverage for Vascepa varies depending on the insurance provider, plan, and patient's medical history. Some insurance plans may cover Vascepa, while others may not. Here are some factors that can affect insurance coverage:

* Formulary status: Vascepa may be listed on the insurance plan's formulary, which determines the medications covered.
* Tiered copayment: Insurance plans may have tiered copayment structures, where Vascepa is placed in a higher tier, resulting in a higher copayment.
* Prior authorization: Insurance plans may require prior authorization for Vascepa, which can delay or deny coverage.
* Patient's medical history: Patients with a history of heart disease, high triglycerides, or other health conditions may be more likely to have insurance coverage for Vascepa.

What Can Patients Do?

Patients who are struggling to afford Vascepa can take several steps:

* Talk to their doctor: Patients should discuss their financial concerns with their doctor, who may be able to provide guidance on alternative medications or treatment options.
* Contact the manufacturer: Patients can contact the manufacturer's patient assistance program to see if they are eligible for financial assistance.
* Apply for patient assistance programs: There are several patient assistance programs available, such as the Vascepa Patient Assistance Program, which can provide financial assistance to eligible patients.

Conclusion

Vascepa is a highly effective medication for treating high triglycerides, but its high cost can be a significant barrier for many patients. While insurance coverage for Vascepa varies, patients can take several steps to access the medication, including talking to their doctor, contacting the manufacturer, and applying for patient assistance programs.

Frequently Asked Questions

1. Is Vascepa covered by Medicare?

Vascepa is covered by Medicare Part D, but coverage may vary depending on the patient's plan and medical history.

2. Is Vascepa covered by Medicaid?

Vascepa is not typically covered by Medicaid, but patients may be eligible for financial assistance programs.

3. Can I get financial assistance for Vascepa?

Yes, patients may be eligible for financial assistance programs, such as the Vascepa Patient Assistance Program.

4. How do I get Vascepa prescribed?

Patients should talk to their doctor about their high triglycerides and ask if Vascepa is a suitable treatment option.

5. What are the side effects of Vascepa?

Common side effects of Vascepa include nausea, diarrhea, and headache. Patients should talk to their doctor about potential side effects and any concerns they may have.

Cited Sources

1. DrugPatentWatch.com. (2022). Vascepa (icosapent ethyl) 1,000mg capsule. Retrieved from <https://www.drugpatentwatch.com/patent/US-8,648,044>
2. National Lipid Association. (2020). Vascepa (icosapent ethyl) for the treatment of high triglycerides. Retrieved from <https://www.lipid.org/vascepa-icosapent-ethyl-treatment-high-triglycerides>