Breztri costs vary based on your Medicare plan and pharmacy, but most seniors pay between $0 and $500 per month out of pocket

Breztri (budesonide/glycopyrrolate/formoterol) is an inhaled medication for chronic obstructive pulmonary disease (COPD). What you pay depends on three things: which Medicare plan you have, which pharmacy you use, and where you fall in the coverage gap called the "donut hole." There is no single price — even two people on the same plan can pay different amounts at different pharmacies.

If you have Original Medicare (Part A and B), you pay 20% of the cost after you meet your Part B deductible, but only if your doctor prescribes it as an injectable or infusion. Most people get Breztri as an inhaler, which means it falls under Part D (prescription drug coverage), not Part B. If you have a Medicare Advantage plan with drug coverage, your cost depends entirely on that plan's formulary — the list of drugs it covers and at what price tier.

Key Takeaways

  • Breztri is usually covered under Medicare Part D (prescription drug plans), not Part B, so your out-of-pocket cost depends on your specific plan's formulary and your pharmacy.
  • Most Medicare plans place Breztri on a higher cost tier (Tier 3 or 4), meaning you pay a copay of $35 to $100 or more per month, or coinsurance of 25% to 33% of the drug cost.
  • Once you spend enough on drugs to enter the coverage gap (donut hole), you pay a higher percentage until you reach catastrophic coverage, where Medicare pays most of the cost.
  • The same medication costs different amounts at different pharmacies, so comparing prices at CVS, Walgreens, Walmart, and independent pharmacies can save you $50 to $200 per month.
  • GlaxoSmithKline, the manufacturer, offers a copay card that can reduce your monthly cost to $0 to $50 if you meet income requirements.

How Medicare Part D covers Breztri

Part D plans organize drugs into tiers, and Breztri typically lands on Tier 3 or Tier 4 — the higher tiers. Tier 1 drugs (generic, low-cost) might have a $5 copay. Tier 3 and 4 drugs have copays of $35 to $100 or more, or you pay coinsurance (a percentage of the cost) instead of a flat copay. A coinsurance of 25% to 33% means if Breztri costs $300, you pay $75 to $100.

Your plan's formulary is the document that lists which tier Breztri is on for your specific plan. You can find this on your plan's website or by calling the plan's customer service number on your insurance card. The formulary changes every year, so even if Breztri was on Tier 3 last year, it might move to Tier 4 in January.

Some plans require prior authorization before they will cover Breztri, meaning your doctor must submit paperwork proving you have tried other COPD medications first. This can delay your first prescription by a few days to a week. A few plans may require you to try a generic or lower-cost alternative before covering Breztri, a practice called step therapy.

The coverage gap and what happens after

In 2024, the Part D coverage gap (donut hole) begins after you and your plan have spent $5,850 combined on covered drugs. Once you enter the gap, you pay a higher percentage of the drug cost — currently 25% for most drugs — until your out-of-pocket spending reaches $8,550. At that point, you enter catastrophic coverage, where Medicare pays 80% and you pay 20% for the rest of the year.

If you take Breztri year-round, you may hit the coverage gap by mid-year or later, depending on your other medications. During the gap, your monthly cost for Breztri could jump from a $50 copay to $75 or more (25% of the drug cost). Once you reach catastrophic coverage, your cost drops again because Medicare covers most of it.

These dollar amounts change each year, so ask your plan or pharmacist to estimate when you will enter the gap based on your current medications. Some people benefit from switching to a different Part D plan during open enrollment (October 15 to December 7) if their current plan puts them in the gap too early.

Pharmacy prices and how to compare

Breztri is a brand-name drug with no generic version, so the pharmacy you choose matters more than it would for a generic medication. The same insurance plan may reimburse different pharmacies at different rates, which means your copay or coinsurance can vary. A CVS pharmacy might charge you $60 per month while a Walmart pharmacy charges $45 for the same prescription under the same plan.

Use the GoodRx website or app, or call pharmacies directly, to compare prices before you fill the prescription. Tell the pharmacist your insurance plan name and ask what your out-of-pocket cost will be. Some independent pharmacies negotiate different rates than large chains and may offer a lower price. If you do not have a Part D plan, GoodRx prices (which are cash prices) can be lower than what you would pay without insurance.

If your copay seems high, ask the pharmacist whether the plan covers a generic alternative or a different brand-name COPD inhaler at a lower tier. Your doctor may be able to switch you to a medication with a lower copay if Breztri is not working better than the alternative.

Manufacturer copay information and other discounts

GlaxoSmithKline, the company that makes Breztri, offers a copay card program. If you may have access to based on income (usually up to 400% of the federal poverty line, which is roughly $62,000 per year for a single person in 2024), you can reduce your monthly copay to $0 to $50. You do not need to be uninsured to use the card — it works alongside Medicare Part D.

To learn about you may have access to, visit the Breztri website or call 1-844-BREZTRI (1-844-273-9874). You will need to provide income information. The copay card is mailed to you and works at most pharmacies. Some plans may not allow copay cards, so confirm with your pharmacy before you explore.

If you cannot afford Breztri even with the copay card, ask your doctor about patient information programs run by GlaxoSmithKline. These programs provide the medication free or at a reduced cost to people who meet income and insurance requirements. Your doctor's office or the manufacturer's website can help you start the process.

Medicare Advantage plans and Breztri

If you have a Medicare Advantage plan (Part C), drug coverage is built in, and your cost for Breztri depends on that plan's formulary. Some Advantage plans cover Breztri on a lower tier than Original Medicare plans do, while others place it higher. You will need to check your plan's formulary or call the plan to find out your specific copay or coinsurance.

Medicare Advantage plans often have a lower monthly premium than Original Medicare plus a separate Part D plan, but they may have higher copays for brand-name drugs like Breztri. During open enrollment, compare what you would pay for Breztri under your current Advantage plan versus switching to Original Medicare with a standalone Part D plan. The difference can be $100 or more per month.

Questions to ask your doctor and pharmacist

Before you fill a Breztri prescription, ask your doctor: "Is Breztri the best option for my COPD, or are there other inhalers that work similarly?" Your doctor may know of a medication on a lower cost tier that would work just as well for you. Ask whether your plan requires prior authorization or step therapy, and if so, whether your doctor is willing to submit the paperwork.

At the pharmacy, ask: "What is my out-of-pocket cost for a one-month supply?" and "Does this plan cover any generic COPD inhalers at a lower copay?" Ask whether the pharmacy accepts the GlaxoSmithKline copay card, and whether switching to a different pharmacy would lower your cost. If the cost is more than you can afford, tell the pharmacist — they may have other options or know about information programs.

Frequently Asked Questions

Will Medicare cover Breztri if my doctor prescribes it?

Medicare Part D covers Breztri, but your specific plan may require prior authorization or step therapy first. Check your plan's formulary or call your plan to confirm it is covered. If your plan does not cover it, you can ask your doctor to request an exception, though approval is not may provide.

What is the difference between a copay and coinsurance for Breztri?

A copay is a flat dollar amount you pay each month — for example, $50. Coinsurance is a percentage of the drug cost — for example, 25%, which means you pay one-quarter of what Breztri costs. Your plan documents will tell you which one applies to Breztri on your plan.

Can I use the GlaxoSmithKline copay card with Medicare?

Yes, the copay card works with Medicare Part D plans. You must meet income requirements (usually up to 400% of the federal poverty line). Call 1-844-BREZTRI to learn about you may have access to and to request a card.

What should I do if Breztri costs too much?

Compare prices at different pharmacies using GoodRx or by calling ahead. Ask your doctor whether a lower-cost COPD inhaler would work for you. Look into the GlaxoSmithKline copay card or patient information program. If you are in the coverage gap, ask your pharmacist when you will reach catastrophic coverage, when your cost will drop.

Does the price of Breztri change during the year?

The copay or coinsurance you pay can change if you move from one coverage stage to another (initial coverage to the gap to catastrophic). The actual price of the drug does not change, but what you pay out of pocket does. Your plan's formulary can also change if your plan makes updates mid-year, though this is less common.