Medicare Part D Coverage Gap
Nusinersen Cost in the Medicare Donut Hole
In the Medicare Part D coverage gap, patients pay 25% of drug costs for Nusinersen (Nusinersen). That means approximately $31250 per fill at retail. Script Unlock cash prices start from $122500 — compare to find your best option.
Nusinersen Cost Comparison — Donut Hole vs Cash Pay
Retail price
$125000
Donut hole (25%)
$31250
Script Unlock cash
from $122500
How the Medicare Donut Hole Works for Nusinersen
- Initial coverage: you pay your plan copay
- Coverage gap (donut hole): you pay 25% of Nusinersen cost
- Catastrophic coverage: you pay very little once TrOOP reached
- Script Unlock cash price may beat your gap cost-sharing
FAQs — Nusinersen and Medicare Donut Hole
How much does Nusinersen cost in the Medicare donut hole?
In the Medicare Part D coverage gap (donut hole), you typically pay 25% of the drug cost for Nusinersen. Based on a retail price of $125000, that would be approximately $31250. Compare this to Script Unlock's cash price of from $122500 — you may save by paying cash instead of using your Medicare coverage.
Is it cheaper to pay cash for Nusinersen during the donut hole?
It depends on the pharmacy and your specific plan. Script Unlock cash prices start from $122500 — compare this to your specific Medicare plan's donut hole cost for Nusinersen. Some patients find cash pay cheaper; others find Medicare still wins.
Does paying cash for Nusinersen 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.