How Much Does Enbrel Cost With Medicare?
Enbrel (Etanercept) costs an average of $1,726 per Medicare Part D claim, with total Medicare spending of $1698.0M in the latest year. No generic alternative is currently available.
Key Facts: Enbrel Cost
- Medicare Part D avg
- $1,726/claim
- Likely Part D tier
- Tier 4-5 (specialty)
- Annual cost/patient
- $17,327
- Generic available
- No
- Manufacturer
- Amgen
- Treats
- Autoimmune Diseases
- Patent expires
- 2029-11-02
- YoY price change
- -15.2%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Enbrel Medicare Coverage & Out-of-Pocket Cost
Enbrel is covered under Medicare Part D, with the program paying an average of $1,726 per prescription fill. Enbrel typically falls on Tier 4-5 (specialty) of standard Part D formularies. Specialty drugs use coinsurance (25-33% of plan-negotiated price), not flat copays. The 2025 Part D annual out-of-pocket cap is $2,000.
Your actual out-of-pocket cost depends on three factors: (1) formulary tier — your plan's specific placement; (2) deductible status — most plans require you to meet up to a $590 deductible (2025) before copays kick in; (3) coverage phase — initial coverage, then the donut hole was eliminated in 2025, replaced by a hard $2,000 annual out-of-pocket cap under the Inflation Reduction Act. Once you hit $2,000 in true out-of-pocket spending, the rest of your Part D drugs are free for the year.
No generic is currently available for Enbrel. Medicare beneficiaries cannot use manufacturer copay cards (anti-kickback statute prohibits them for federal program enrollees), but charity foundations such as the PAN Foundation, NeedyMeds, and the HealthWell Foundation offer copay grants for many autoimmune diseases drugs. The Medicare Extra Help (LIS) program also reduces Part D costs to near-zero for income-qualified beneficiaries (under 150% of the federal poverty level).
For cash-pay or commercial insurance scenarios, compare prices using GoodRx, SingleCare, or Cost Plus Drugs before filling — discount-program prices sometimes beat Part D copays for lower-cost generics.
Enbrel is manufactured by Amgen and prescribed primarily for Autoimmune Diseases. In the most recent Medicare Part D data, 984,000 claims were filed for 98,000 unique beneficiaries, at an average cost of $1,726 per claim. Average annual cost per beneficiary is $17,327.
Year over year, Medicare spending on Enbrel has decreased by -15.2%. No generic substitute is available, so the brand-name price reflects the full market cost. Its patent expires 2029-11-02.
Enbrel belongs to the Biologics for Autoimmune Diseases class. TNF inhibitors (Humira, Enbrel) block tumor necrosis factor, a protein that drives inflammation. IL-12/23 inhibitors (Stelara) and IL-17 inhibitors (Cosentyx) target specific interleukin pathways. IL-4/13 inhibitors (Dupixent) treat atopic dermatitis and asthma. JAK inhibitors (Rinvoq, Xeljanz) are oral pills that block Janus kinase enzymes inside immune cells.
Key Data
| Metric | Value |
|---|---|
| Avg Cost Per Claim | $1,726 |
| Total Medicare Spending | $1698.0M |
| Total Claims | 984,000 |
| Beneficiaries | 98,000 |
| Generic Available | No |
| Year-Over-Year Change | -15.2% |
Other Drugs for Autoimmune Diseases
Frequently Asked Questions
Medicare Part D pays an average of $1,726 per claim for Enbrel. Enbrel is typically placed on Tier 4-5 (specialty) of standard Part D formularies. Specialty drugs use coinsurance (25-33% of plan-negotiated price), not flat copays. The 2025 Part D annual out-of-pocket cap is $2,000. As of 2025, total annual out-of-pocket on Part D is capped at $2,000 under the Inflation Reduction Act.
Yes. Enbrel appears in Medicare Part D claims data, with 98,000 beneficiaries filling 984,000 prescriptions in the latest year. Specific coverage depends on your plan's formulary — call the number on your insurance card or check the plan's Summary of Benefits to confirm prior authorization, step therapy, or quantity limit requirements.
Enbrel (Etanercept) costs an average of $1,726 per Medicare Part D claim, with total Medicare spending of $1698.0M in the latest year. No generic alternative is currently available.
No. As of the latest FDA Orange Book data, there is no generic version of Enbrel (Etanercept). Patent protection extends until 2029-11-02, after which generics may enter the market.
Medicare beneficiaries cannot use manufacturer copay cards (anti-kickback statute), but several options exist: (1) Apply to charity copay foundations like the PAN Foundation, NeedyMeds, HealthWell Foundation, or Patient Advocate Foundation — many cover autoimmune diseases drugs; (2) Ask your prescriber about therapeutic alternatives in the same drug class that may be on a lower tier; (3) For some drugs, paying cash via GoodRx or Cost Plus Drugs can beat your Medicare copay — always compare before filling; (4) If your income is below 150% of the federal poverty level, you may qualify for the Medicare Extra Help (Low-Income Subsidy) program, which reduces Part D costs to near-zero.
Enbrel is manufactured by Amgen. The FDA application number is BLA103795.
Enbrel (Etanercept) is primarily prescribed for Autoimmune Diseases.
Medicare Part D spending on Enbrel has decreased -15.2% year over year. Total program spending reached $1698.0M in the latest reporting year.
Enbrel (Etanercept) costs an average of $1,726 per Medicare Part D claim, with total Medicare spending of $1698.0M in the latest year. No generic alternative is currently available.
The data source behind this answer is CMS Medicare Part D Drug Spending data. Every figure on the page traces back to that source; the methodology page describes the inputs and the refresh cadence in full detail.
For readers turning this answer into action: cross-reference against the underlying CMS Medicare Part D Drug Spending data record before acting on time-sensitive decisions. The site renders the data as it was published; subsequent revisions can shift the picture, and the live federal data is always the authoritative current reference.
Source: CMS Medicare Part D Spending, 2026.