Cimzia Medicare Coverage

Cimzia is a prescription medication that contains the active ingredient Certolizumab. Cimzia is a subcutaneous injection into the fatty part of the skin given every 2 to 4 weeks depending on the condition being treated.

Cimzia binds and neutralizes human TNF-alpha in the body to reduce inflammatory processes.

The major side effects of Cimzia include irritation where the shot is given and signs of a common cold.

How much does Cimzia cost with Medicare?

Cimzia coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Cimzia?

According to GoodRx, 35% of Medicare Advantage plans and Medicare Part D plans covered Cimzia in 2023.¹

• Medicare Advantage plans or Part D plans that cover Cimzia include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Cimzia. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Additional information

Tell your doctor you are taking Cimzia before getting any vaccines, as it may have an impact on their effectiveness.

While many patients can safely take Cimzia, patients who are pregnant or breastfeeding should take extra precautions. Talk to your doctor about the risks and benefits of the medication.

Patients treated with Cimzia are at a higher risk of developing serious infections including tuberculosis or invasive fungal, bacterial, viral or other opportunistic infections. Monitor closely for signs/symptoms of infection.

Wash your hands often and stay away from people who are sick.

Lymphoma and other cancers have occurred in patients who take Cimzia; be sure to talk with your doctor about the benefits and risks.

Use with caution if you have heart failure or kidney impairment. Patients taking Cimzia have experienced new-onset and worsening heart failure, and part of the drug may be dependent on kidney function.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.