How Much Does Fentanyl Cost With Medicare?
Fentanyl (Fentanyl Transdermal) costs an average of $72 per Medicare Part D claim, with total Medicare spending of $178.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Key Facts: Fentanyl Cost
- Medicare Part D avg
- $72/claim
- Likely Part D tier
- Tier 1 (generic)
- Annual cost/patient
- $597
- Generic available
- Yes — Fentanyl Transdermal
- Manufacturer
- Janssen
- Treats
- Pain
- YoY price change
- -28.6%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Fentanyl Medicare Coverage & Out-of-Pocket Cost
Fentanyl is covered under Medicare Part D, with the program paying an average of $72 per prescription fill. Fentanyl typically falls on Tier 1 (generic) of standard Part D formularies. Typical copay: $0-$10 per fill on most Medicare Part D plans.
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.
Because generic Fentanyl Transdermal is available, the single biggest savings move is asking your pharmacist about generic substitution. Generics typically sit on Tier 1 with copays under $10, vs Tier 2-3 placement for brand-name Fentanyl. Most states allow automatic substitution unless your prescriber writes "dispense as written."
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.
Fentanyl is manufactured by Janssen and prescribed primarily for Pain. In the most recent Medicare Part D data, 2,480,000 claims were filed for 298,000 unique beneficiaries, at an average cost of $72 per claim. Average annual cost per beneficiary is $597.
Year over year, Medicare spending on Fentanyl has decreased by -28.6%. Because a generic version of Fentanyl Transdermal is available, patients can often substitute to reduce out-of-pocket costs. Its patent expires 2023-01-31.
Key Data
| Metric | Value |
|---|---|
| Avg Cost Per Claim | $72 |
| Total Medicare Spending | $178.0M |
| Total Claims | 2,480,000 |
| Beneficiaries | 298,000 |
| Generic Available | Yes |
| Year-Over-Year Change | -28.6% |
Other Drugs for Pain
Frequently Asked Questions
Medicare Part D pays an average of $72 per claim for Fentanyl. Fentanyl is typically placed on Tier 1 (generic) of standard Part D formularies. Typical copay: $0-$10 per fill on most Medicare Part D plans. As of 2025, total annual out-of-pocket on Part D is capped at $2,000 under the Inflation Reduction Act.
Yes. Fentanyl appears in Medicare Part D claims data, with 298,000 beneficiaries filling 2,480,000 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.
Fentanyl (Fentanyl Transdermal) costs an average of $72 per Medicare Part D claim, with total Medicare spending of $178.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Yes. A generic version of Fentanyl Transdermal is available, which typically costs 80-95% less than brand-name Fentanyl. Ask your pharmacist about generic substitution — most state laws allow automatic substitution unless your prescriber writes "dispense as written."
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 pain 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.
Fentanyl is manufactured by Janssen. The FDA application number is BLA125057.
Fentanyl (Fentanyl Transdermal) is primarily prescribed for Pain.
Medicare Part D spending on Fentanyl has decreased -28.6% year over year. Total program spending reached $178.0M in the latest reporting year.
Fentanyl (Fentanyl Transdermal) costs an average of $72 per Medicare Part D claim, with total Medicare spending of $178.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
This answer pulls from CMS Medicare Part D Drug Spending data, the authoritative federal source for U.S. Medicare prescription-drug pricing. The headline number above is the direct answer; what follows is the additional context most readers need to use the answer for a real decision rather than just a fact lookup.
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.