Secukinumab (Cosentyx) and Medicare
Since 2023 Cosentyx comes two ways: the pen you use at home, and an infusion. Medicare pays for them out of two different pockets, and the difference to you is large.
The short answer
- The pen or syringe you use at home is covered by your Part D drug plan. Your costs stop at $2,100 for the whole year in 2026.
- The infusion is covered by Part B. You pay 20% of the cost with no yearly limit — somewhere around $6,600 or more, depending on your weight and how the infusion center bills the leftover medication in the vial.
For most people on Medicare, the pen is the cheaper option by thousands of dollars. That flips only if you have a Medicare supplement policy, which covers the 20% and leaves you paying almost nothing for the infusion.
One thing to know before you consider switching: the infusion is not approved for plaque psoriasis. It is approved for psoriatic arthritis, ankylosing spondylitis and non-radiographic axial spondyloarthritis only.
Side by side
| Pen or syringe at home | Infusion at a clinic | |
|---|---|---|
| Which part of Medicare | Part D — your drug plan | Part B — regular Medicare |
| How often | Once a month, after the loading doses | Every 4 weeks |
| Which conditions | Psoriatic arthritis, ankylosing spondylitis, axial spondyloarthritis, plaque psoriasis | Psoriatic arthritis, ankylosing spondylitis, axial spondyloarthritis — not psoriasis |
| Cost before insurance | About $102,000 a year at list price | About $33,000 a year at Medicare’s rate |
| What you pay | Capped at $2,100 | About $6,600, no ceiling |
| With a Medicare supplement | No change — still $2,100 | The supplement pays the 20%. Often about $283. |
| Will a plan cover it? | Yes — about 76% of plans, and 90% of standalone drug plans | Yes — Part B covers it |
| Approval needed first? | Yes, on virtually every plan | No, under Original Medicare |
The infusion is dosed by weight, so a heavier person pays more. Cosentyx comes in 125 mg vials, and if your dose does not divide neatly into whole vials, Medicare is billed for the leftover too — which can push your 20% substantially higher than the figure above. It is a fair question to ask your infusion center.
Good news: this one is usually covered
Some biologics are technically capped under Part D but almost impossible to find a plan that covers them. Cosentyx is not one of them. We went through the 2026 formularies CMS published: about 76% of all Medicare drug plans cover the pen, and nearly 90% of standalone drug plans do.
The catch is milder but real: virtually every plan that covers it requires approval first, and nearly all of them put it on the specialty tier. That is universal, so it is not a reason to pick one plan over another. It is a reason to start the paperwork early and to watch for the renewal each January.
Approvals and being made to try something else first
Original Medicare requires no prior authorization for the infusion given in a doctor’s office, and cannot require you to fail a different medication first.
Medicare Advantage plans can require both. One 2026 plan policy requires patients to try and fail two other infused biologics and — for members with drug coverage — adalimumab and the Cosentyx pen, before it will pay for the Cosentyx infusion. That is four medications ahead of the one your rheumatologist chose.
Policies vary a lot between plans, which is exactly why it is worth checking the specific plan rather than assuming. If a request is denied, appeal — across Medicare Advantage in 2024, 81% of the denials that were appealed were overturned, and only about one in nine was ever appealed.
Things that surprise people
- There is no cheaper version. Secukinumab has no biosimilars, and none are close. So the usual “ask about the biosimilar” advice does not apply here.
- The Cosentyx copay card does not work if you have Medicare. Federal law prohibits it. The Novartis patient assistance foundation does serve Medicare patients, and is worth applying to if the $2,100 is out of reach.
- The whole $2,100 can land in January. Medicare has a program that spreads it across twelve interest-free monthly payments, but you have to sign up for it.
- Switching from the pen to the infusion moves you out of a capped benefit into an uncapped one. That is only a good trade if you have a supplement policy.
- Extra Help can bring the specialty-tier cost down to a few dollars if your income is modest. Check before you assume you do not qualify.
Free help, from someone who is not paid a commission
- Washington: SHIBA — insurance.wa.gov/shiba or 1-800-562-6900
- Any other state: SHIP — shiphelp.org
- Check your plan covers it — medicare.gov/plan-compare
- Spread the January cost — medicare.gov/prescription-payment-plan
- Extra Help — ssa.gov/medicare/part-d-extra-help
Why isn’t my infusion covered by the $2,100 cap?
Because the $2,100 cap only applies to Part D, and an infusion is paid by Part B. The cap Congress created covers drugs you pick up and take yourself. A medication a nurse or doctor gives you is paid under Part B instead, where you owe 20% of the cost every time and there is no annual ceiling at all.
It is the same Medicare, often the same drug, and frequently the same disease. The rulebook is chosen by who puts the medicine in you. Almost everything written about the cap leaves this out, so people on infusions read that their costs are now limited, and then the bills keep coming.
A worked example. If Medicare’s approved amount for a year of your infusions is $18,000, you owe about $3,600 — this year, next year, and every year you stay on it. The $2,100 cap does not apply to any of it.
Four things do put a ceiling on Part B costs:
- A Medicare supplement (Medigap) policy, which pays the 20% for you. This is the main one, and the window to buy one closes six months after you enroll in Part B in most states.
- A Medicare Advantage plan’s yearly out-of-pocket maximum, which applies to everything the plan covers — though it comes with prior authorization attached.
- QMB, a Medicare Savings Program that eliminates the 20% entirely. This is the one people are not told about — and note that Extra Help, which people are told about, does nothing for a Part B drug.
- Full Medicaid, or retiree coverage that pays after Medicare.
Related
- Medicare and your medication
- Why your medication needs permission first
- Golimumab (Simponi) and Medicare — the same two-route question with the opposite answer
- Where you get infused changes the bill — the same infusion costs more at a hospital, and the bill nobody warns you about
Where these figures come from
- Cosentyx prescribing information — FDA. Subcutaneous: 150 mg at weeks 0, 1, 2, 3 and 4 then every 4 weeks for psoriatic arthritis and spondyloarthritis, with escalation to 300 mg permitted; 300 mg loading and maintenance for plaque psoriasis. Intravenous: 6 mg/kg at week 0 then 1.75 mg/kg every 4 weeks, capped at 300 mg per dose, supplied in 125 mg vials. The intravenous form was approved in October 2023 for psoriatic arthritis, ankylosing spondylitis and non-radiographic axial spondyloarthritis; it is not approved for plaque psoriasis.
- Medicare payment limit for intravenous secukinumab (J3247): $18.233 per mg — CMS Part B ASP pricing file effective July 1 – September 30, 2026. Annual figure assumes an 80 kg adult on maintenance dosing; billing for discarded medication in partially used vials can raise it substantially.
- Novartis published list price, January 2026: $8,492.03 per monthly subcutaneous package, about $101,900 a year; $4,489.34 per intravenous infusion.
- Part D annual out-of-pocket cap $2,100 and deductible $615 for 2026 — CMS Final CY2026 Part D Redesign Program Instructions. Part B annual deductible $283 and 20% coinsurance with no annual limit — CMS, “2026 Medicare Parts A & B Premiums and Deductibles.”
- Formulary coverage of subcutaneous Cosentyx: 4,151 of 5,490 plans (75.6%), of which 97.5% require prior authorization and 95.6% place it on the specialty tier; 330 of 367 standalone prescription drug plans (89.9%) — analysis of the CMS Basic Drugs Formulary File, released July 31, 2026. Counted by plan, not weighted by enrolment.
- No FDA-approved secukinumab biosimilar exists as of August 2026 — FDA Drugs@FDA; no biosimilar code appears on the Part B ASP file.
- Step therapy permitted for Medicare Advantage Part B drugs and not in Original Medicare — 42 CFR §422.136. The step therapy example is taken from a regional Medicare Advantage plan’s published medical drug prior authorization list, revised August 2026.
- Medicare Advantage appeal rates and outcomes for 2024 (11.5% of denials appealed, 80.7% overturned) — KFF analysis of CMS data, 2026.
- Copay assistance is prohibited for federal healthcare program beneficiaries — federal Anti-Kickback Statute, 42 U.S.C. §1320a-7b; Cosentyx Co-Pay Plus program terms.
About this page
Written and reviewed by Alison Bays, MD, MPH, board-certified rheumatologist. Figures are current for 2026 and were last checked in August 2026.
This is educational information, not advice — not medical, legal, financial or insurance advice, and not a substitute for talking to your doctor or your plan. Nothing is sold here. No insurance is sold here, no plan is recommended, and neither this page nor its author is paid by any insurance company, plan, pharmaceutical manufacturer or broker. This page is not affiliated with, endorsed by, or connected to Medicare, the Centers for Medicare & Medicaid Services, or any government agency.
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