How much do Tepezza injections for Graves’ eye disease really cost?
Summary
At full list price, a single 500-mg vial of Tepezza costs about $14,900 in the United States. Because most patients need eight infusions (one every three weeks), the before-insurance charge for a complete course usually falls between $120,000 and $160,000. Your actual out-of-pocket cost depends on your insurance deductible, co-insurance rate, specialty pharmacy contracts, manufacturer assistance, and whether you qualify for free-drug programs.
What is the current out-of-pocket price for a full Tepezza course?
Most American hospitals and infusion centers bill Tepezza at the manufacturer list price: about $14,900 per 500-mg vial. A standard dosing regimen uses eight vials, bringing the line-item drug charge close to $120,000. Infusion fees, labs, and ophthalmology follow-ups add another $3,000–$5,000. “In real-world claims data, we see uninsured patients receive bills just shy of $150,000,” notes the team at Eureka Health.
- List price per vial exceeds most household incomesHorizon Therapeutics’ wholesale acquisition cost (WAC) is $14,900, nearly triple the 2022 U.S. median household income of $57,000.
- Eight infusions are standard of careThe FDA-approved protocol (10 mg/kg on infusion 1, then 20 mg/kg for infusions 2–8) translates to roughly one vial per treatment for an average-weight adult.
- Facility fees add thousandsHospital-based infusion centers typically charge $300–$800 per visit for chair time, IV supplies, and nursing supervision.
- Cash-pay discounts are uncommonBecause Tepezza is distributed through limited specialty pharmacies, self-pay patients rarely obtain more than a 10 % discount.
- Manufacturer assistance can erase the billHorizon’s Patient Access Program covers 100 % of drug cost for qualifying uninsured or under-insured U.S. residents earning under 400 % of the federal poverty level.
- Retail price listings top $17,000 per vialDrugs.com lists a single 500-mg Tepezza vial at about $17,260, showing that some pharmacies charge even more than the hospital wholesale price. (Drugs.com)
- Commercial patients may qualify for a $0 co-payThe manufacturer notes that eligible privately insured patients can use the Horizon Commercial Co-Pay Program to reduce both the medication and infusion fees to zero out-of-pocket. (Tepezza)
Which financial red flags should Graves’ patients watch for before starting Tepezza?
Sticker shock is not the only risk. “Surprise billing most often occurs when the infusion site is out of network, even if the drug itself is covered,” warns Sina Hartung, MMSC-BMI.
- Prior authorization denial can stall therapyRoughly 1 in 5 commercial plans initially deny Tepezza claims; appeals add 2–6 weeks of delay.
- Facility-out-of-network status spikes coinsuranceIf the infusion suite is not contracted with your plan, coinsurance may jump from 20 % to 50 %, adding $50,000 or more to patient liability.
- Deductible resets every JanuaryStarting therapy in December may leave you paying two deductibles (one for dose 1, one for doses 2–8 after the new year).
- Missed infusion fees applyMany centers charge $250 or more if you cancel within 24 hours because the vial has already been ordered and cannot be returned.
- Balance billing is legal in some statesIn states without surprise-billing protection, providers can bill you the difference between their charge and insurer payment.
- Full course list price exceeds $138,000 before facility feesAt a cash price of roughly $17,260 per 500-mg vial, an eight-dose regimen can cost more than $138,000 for the drug alone if insurance approval lapses mid-therapy. (Drugs.com)
- Medicare patients do not qualify for $0 copay assistanceThe manufacturer’s copay program is limited to commercial insurance; people on Medicare, Medicaid, or other government coverage remain responsible for their Part B coinsurance unless they secure foundation aid. (TPC)
Why do two patients with the same diagnosis pay very different amounts?
Price variation reflects insurance design, weight-based dosing, and provider contracts. “We’ve seen zero-dollar copays for a 90-kg teacher on union insurance and $35,000 bills for a similarly sized contractor with a high-deductible plan,” says the team at Eureka Health.
- Body weight determines vial countA 50-kg person needs 400 mg per infusion (≈0.8 vial) while a 100-kg person needs 800 mg (≈1.6 vials), doubling drug cost.
- Commercial vs. Medicare rules differMost commercial plans classify Tepezza as a pharmacy benefit; Medicare Part B treats it as a medical benefit with 20 % coinsurance unless a Medigap plan applies.
- Copay maximizer programs cap expensesSome insurers apply manufacturer assistance toward the patient’s cost share, limiting copays to <$50 per infusion.
- Infusion site contracts vary widelyAn academic hospital may bill 250 % of Medicare rates; a standalone infusion suite may accept 120 %.
- State mandates affect coverageTwenty-three states require insurers to cover at least one FDA-approved thyroid eye disease therapy, reducing denial rates.
- List price tops $17,000 per 500-mg vialDrugs.com lists a cash price of roughly $17,260 for a single 500-mg Tepezza vial—before any facility or administration fees are added. (Drugs.com)
- Retail cash quotes can exceed $52,000 per treatmentGoodRx reports out-of-pocket prices as high as $52,326 for one Tepezza infusion when no insurance or discounts apply. (GoodRx)
Can I reduce my personal Tepezza cost without delaying care?
Yes—planning and advocacy help. Sina Hartung, MMSC-BMI, advises, “Secure prior authorization first, then shop infusion sites before scheduling dose 1.”
- Request a single-case agreementIf your insurer lacks a contract with a low-cost infusion center, negotiate a one-time in-network rate.
- Time therapy around deductible statusCompleting all eight infusions within one policy year often halves patient liability.
- Use Horizon’s Copay Assistance CardCommercially insured patients can reduce out-of-pocket cost to as low as $0, subject to annual maximums of $15,000.
- Ask about home infusionSelect insurers approve at-home administration, saving $200–$500 per visit in facility fees.
- Set up an interest-free payment planMany centers allow 12- to 24-month payment terms, preventing credit card interest.
- Know the baseline price before negotiatingTepezza’s wholesale cost runs about $17,260 per 500-mg vial—roughly $138,000 for the standard eight-infusion course—so even small percentage discounts translate into several thousand dollars saved. (Drugs.com)
- Seek foundation grants if you have Medicare or no insuranceIncome-based programs such as PAN Foundation or The Assistance Fund can provide need-based grants for drug and infusion charges that manufacturer copay cards cannot cover. (Amgen)
What labs, imaging, and medications impact total treatment cost?
Beyond the drug itself, baseline and monitoring tests add predictable charges. “Budgeting an extra $1,000 for MRI, thyroid labs, and pre-infusion CBC saves unpleasant surprises,” notes the team at Eureka Health.
- Thyroid function panels every 3 monthsTSH, Free T4, and Total T3 run $80–$150 without insurance and detect fluctuating thyroid control during therapy.
- HbA1c for diabeticsBecause Tepezza can worsen hyperglycemia, most endocrinologists order HbA1c ($35–$50) before dose 1 and after dose 4.
- Orbital CT or MRI pre-authorizationCross-sectional imaging ($600–$1,200) documents proptosis and is often required by insurers to justify the drug.
- Steroid pre-medication is low costA single 40 mg prednisone tablet given before each infusion costs <$1 but helps prevent infusion reactions.
- Managing side effects may add scriptsOver-the-counter NSAIDs for muscle cramps or prescriptions like ondansetron for nausea usually stay under $20 per fill.
- Each 500-mg Tepezza vial runs about $17,260, so the standard 8-infusion course can exceed $138,000 before facility or infusion feesThe drug itself is the single largest cost driver, far outstripping the price of routine labs and imaging. (Drugs)
- Comparative therapy with intravenous methylprednisolone still adds roughly $4,000 per treatment, multiplying quickly when multiple infusions are neededEven ‘cheaper’ steroid infusions contribute thousands to the overall budget when courses extend over several weeks. (RayDouglas)
How can Eureka’s AI doctor streamline Tepezza approval and cost navigation?
Eureka’s AI doctor walks you through a step-by-step prior authorization checklist, flags missing labs, and drafts appeal letters. “Users say the template shortened approval time from six weeks to ten days,” reports Sina Hartung, MMSC-BMI.
- Automated PA form completionUpload your insurance form once; the AI pre-populates ICD-10 codes (e.g., H06.2) and clinical criteria.
- Real-time weight-based dosing calculatorEnter your weight to see exact vial needs and projected copay before you schedule.
- In-app quote comparisonEureka lists average facility fees for local infusion centers, revealing up to $700 difference per visit.
- Appeal letter generatorIf denied, the AI drafts a medically referenced appeal citing OPTIC trial data, often reversing decisions.
- Private chat with a physician reviewerFor complex cases, a board-certified endocrinologist on the Eureka team can review your chart within 24 hours.
Why patients with thyroid eye disease trust Eureka’s AI doctor
Our platform is designed for conditions that fall between endocrinology and ophthalmology, like Graves’ eye disease. The team at Eureka Health notes, “Users managing TED rate the app 4.7 out of 5 for helping them understand treatment options.”
- Symptom tracker links directly to your care teamRecord eye pain, diplopia, and swelling; share an exportable PDF with your ophthalmologist.
- Lab and imaging ordering under physician oversightEureka can order a thyroid panel or orbital CT; a licensed doctor reviews every request.
- Medication safety checksThe AI flags interactions between Tepezza and common drugs like metformin or beta-blockers.
- Education tailored to insurance rulesThe app explains, in plain language, how Medicare vs. commercial copays work for infused biologics.
- Free to use, data kept privateEureka encrypts your information end-to-end and never sells data; the basic version costs nothing.
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Frequently Asked Questions
Is Tepezza covered by Medicare?
Yes, it is covered under Part B as an infused drug, but you are responsible for 20 % coinsurance unless you have a Medigap or Advantage plan that reduces or eliminates the charge.
Can I split the vials to lower cost?
No. Each infusion requires pharmacy compounding from full vials to maintain sterility, and unused drug must be discarded.
What if my insurance denies Tepezza because my TED is "mild"?
You can appeal with photos, Hess charts, and an ophthalmology note documenting functional impact such as diplopia or exposure keratopathy.
Does Horizon provide free Tepezza outside the U.S.?
No. The manufacturer assistance program only covers U.S. residents; other countries rely on national health services or private pay.
How soon after radioactive iodine can I start Tepezza?
Most endocrinologists wait at least 6–8 weeks to confirm thyroid hormone stabilization before starting infusion therapy.
Will my vision insurance help pay?
Typically no; Tepezza is billed through medical insurance because TED is a systemic autoimmune condition, not a refractive error.
Can I pause treatment if I get pregnant?
Tepezza is contraindicated in pregnancy; you must stop therapy and consult both your endocrinologist and obstetrician immediately.
Is there a biosimilar that is cheaper?
As of 2025 no Tepezza biosimilars have FDA approval, so pricing remains fixed by the originator product.
How do I apply for Horizon's Patient Access Program?
Your physician submits an enrollment form with proof of income; approval decisions usually arrive within 1–2 business days.