Orencia® Medicare Coverage

Orencia is a prescription medication that contains the active ingredient Abatacept. Orencia is given every 1 to 2 weeks either by IV or subcutaneous injection.

Orencia binds to immune cells to suppress the immune system and modify the process of inflammation. Orencia also reduces the presence of other inflammatory substances.

The major side effects you may see with Orencia include headache, signs of a common cold, nose and throat irritation, nausea, diarrhea, dizziness, stomach and back pain and irritation where the medication is injected.

How much does Orencia cost with Medicare?

Orencia 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 Orencia?

According to GoodRx, 46% of Medicare Advantage plans and Medicare Part D plans covered Orencia in 2023.¹

• Medicare Advantage plans or Part D plans that cover Orencia 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 Orencia. 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

Serious infections have happened to patients taking Orencia, particularly in patients receiving other immunosuppressive therapy.

Monitor for signs and symptoms of infection such as fever, chills, sore throat, cough, more sputum or change in sputum color, pain with passing urine, mouth sores, or a wound that will not heal. Wash hands often and stay away from people who are sick.

Orencia may worsen the conditions of patients who have Hepatitis A, Hepatitis B or COPD. Orencia may also increase the risk of certain types of cancer because of the immunosuppressive effects. Talk with your doctor about Orencia’s risks and benefits.

Orencia is not recommended for women who are pregnant or breastfeeding. Patients who are pregnant or breastfeeding should use an alternative, safer medication to treat their condition unless no other pregnancy-compatible medication is able to control disease.

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.