Around 69% of national commercial plans (usually offered by employers) cover Gemtesa (vibegron) making the average total cost being anywhere from $0 to $10 for a complete dose. In addition, around 85% of Medicare Part D covers Gemtesa (vibegron), as well.
Key Takeaways
Patients who have interstitial cystitis (IC) may also be suggested to take Gemtesa (vibegron) for their issues. Interstitial cystitis (IC) is a condition that causes discomfort in the bladder or pelvic area with a frequent feeling of needing to urinate. However, Gemtesa is not currently approved by the FDA for the treatment of interstitial cystitis (IC), which may cause your insurance to deny the request for coverage.
Around 85% of Medicare Part D coverage covers Gemtesa (vibegron) including AARP Medicare Advantage Choice plans, Anthem MediBlue Preferred plans, and Cigna Secure Rx plans.
Gemtesa (Vibegron) Insurance Coverage
According to a tear sheet distributed by Gemtesa, the following health plans have coverage for Gemtesa (making it around 85% of Medicare lives in the United States covered):
Plan Name | Coverage Status |
AARP Medicare Advantage Choice | Medicare Covered |
AARP MedicareRx Preferred | Medicare Covered |
Anthem MediBlue Preferred | Medicare Covered |
Cigna Secure Rx | Medicare Covered |
Express Scripts EGWP Premier Access 4 Tier | Medicare Covered (PA/ST) |
Humana Walmart Value Rx Plan | Medicare Covered |
UnitedHealthcare Group Medicare Advantage (PPO) EGWP | Medicare Covered |
WellCare Classic PDP | Medicare Covered |
If you don’t see your plan name listed above, there may be a chance that your Gemtesa (vibegron) prescription would not be covered. 69% of national commercial plans also cover Gemtesa for overactive bladder.
Why Gemtesa Prescription Was Denied by Your Insurance
Patients who have interstitial cystitis (IC) may also be suggested to take Gemtesa (vibegron) for their issues. Interstitial cystitis (IC) is a condition that causes discomfort in the bladder or pelvic area with a frequent feeling of needing to urinate.
However, the FDA has not yet approved Gemtesa (vibegron) to be prescribed for patients with interstitial cystitis (IC) and is only approved for patients suffering from overactive bladder (OB). As a result, your commercial insurer may deny your request to have the medication covered.
Cheapest Ways to Get Gemtesa (Vibegron)
Along with the Gemtesa savings program that can lower your cost to as little as $95 for a 30-day supply, you can also use licensed online Canadian pharmacies. These licensed pharmacies, such as DrugMart.com offer a 30-tablet dose of Gemtesa (Vibegron) for only $130.67. That makes the average cost per unit only around $4.35 compared to the average per unit cost of $17.39. 90-day tablet costs are $309.60, which brings the average cost per unit to as low as $3.44. Which is a significant savings compared to the total average cost of a 30-tablet supply being $521.58.
To purchase, please visit our Gemtesa page right here.
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Sources
HMP Global. (2023). GEMTESA National Multi Medicare Formtrak. Retrieved December 1, 2024, from https://s3.amazonaws.com/HMP/Ad+Ops/2023/ALTC/Gemtesa-071223/GEMTESA+National+Multi+Medicare+Formtrak.pdf
The Medical Letter. (2023). Vibegron (Gemtesa) for overactive bladder. The Medical Letter on Drugs and Therapeutics, 62(1623). Retrieved November 12, 2024, from https://secure.medicalletter.org/system/files/private/TML-article-1623c.pdf
U.S. Food and Drug Administration. (2020). Original NDA approval for Gemtesa (NDA 213006). Retrieved November 15, 2024, from https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/213006Orig1s000Approv.pdf
Sumitomo Pharma. (2023). Notice regarding approval of vibegron (generic name) in China for overactive bladder treatment. Retrieved November 13, 2024, from https://www.sumitomo-pharma.com/news/assets/pdf/ene20230912.pdf
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