Medicare Part D Coverage Gap
Nirsevimab Cost in the Medicare Donut Hole
In the Medicare Part D coverage gap, patients pay 25% of drug costs for Nirsevimab (Nirsevimab-alip). That means approximately $124 per fill at retail. Script Unlock cash prices start from $421 — compare to find your best option.
Nirsevimab Cost Comparison — Donut Hole vs Cash Pay
Retail price
$495
Donut hole (25%)
$124
Script Unlock cash
from $421
How the Medicare Donut Hole Works for Nirsevimab
- Initial coverage: you pay your plan copay
- Coverage gap (donut hole): you pay 25% of Nirsevimab cost
- Catastrophic coverage: you pay very little once TrOOP reached
- Script Unlock cash price may beat your gap cost-sharing
FAQs — Nirsevimab and Medicare Donut Hole
How much does Nirsevimab cost in the Medicare donut hole?
In the Medicare Part D coverage gap (donut hole), you typically pay 25% of the drug cost for Nirsevimab. Based on a retail price of $495, that would be approximately $124. Compare this to Script Unlock's cash price of from $421 — you may save by paying cash instead of using your Medicare coverage.
Is it cheaper to pay cash for Nirsevimab during the donut hole?
It depends on the pharmacy and your specific plan. Script Unlock cash prices start from $421 — compare this to your specific Medicare plan's donut hole cost for Nirsevimab. Some patients find cash pay cheaper; others find Medicare still wins.
Does paying cash for Nirsevimab count toward my Medicare deductible or donut hole?
Generally no — paying cash typically does not count toward your Medicare Part D True Out-of-Pocket (TrOOP) spending that helps you exit the coverage gap. However, this can be worthwhile if the cash price is significantly lower than your donut hole cost-sharing. Consult your Medicare plan's EOB for your specific situation.
This information is for educational purposes. Medicare Part D coverage gaps vary by plan. Consult your plan's EOB and a Medicare counselor for personalized guidance.