How Much Does Gilenya Cost With Medicare?
Gilenya (Fingolimod) costs an average of $5,738 per Medicare Part D claim, with total Medicare spending of $1423.0M in the latest year. No generic alternative is currently available.
Key Facts: Gilenya Cost
- Medicare Part D avg
- $5,738/claim
- Likely Part D tier
- Tier 4-5 (specialty)
- Annual cost/patient
- $64,682
- Generic available
- No
- Manufacturer
- Novartis
- Treats
- Multiple Sclerosis
- Patent expires
- 2027-09-22
- YoY price change
- -14.8%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Gilenya Medicare Coverage & Out-of-Pocket Cost
Gilenya is covered under Medicare Part D, with the program paying an average of $5,738 per prescription fill. Gilenya 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 Gilenya. 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 multiple sclerosis 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.
Gilenya is manufactured by Novartis and prescribed primarily for Multiple Sclerosis. In the most recent Medicare Part D data, 248,000 claims were filed for 22,000 unique beneficiaries, at an average cost of $5,738 per claim. Average annual cost per beneficiary is $64,682.
Year over year, Medicare spending on Gilenya has decreased by -14.8%. No generic substitute is available, so the brand-name price reflects the full market cost. Its patent expires 2027-09-22.
Gilenya belongs to the Multiple Sclerosis (MS) Treatments class. B-cell depleting therapies (Ocrevus, Kesimpta) destroy B-cells that attack myelin. S1P receptor modulators (Gilenya, oral) trap white blood cells in lymph nodes. Fumarates (Tecfidera) have anti-inflammatory and neuroprotective effects. Interferons (older DMTs) modulate the immune response. Each mechanism targets a different part of the immune system's attack on the nervous system.
Key Data
| Metric | Value |
|---|---|
| Avg Cost Per Claim | $5,738 |
| Total Medicare Spending | $1423.0M |
| Total Claims | 248,000 |
| Beneficiaries | 22,000 |
| Generic Available | No |
| Year-Over-Year Change | -14.8% |
Other Drugs for Multiple Sclerosis
Frequently Asked Questions
Medicare Part D pays an average of $5,738 per claim for Gilenya. Gilenya 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. Gilenya appears in Medicare Part D claims data, with 22,000 beneficiaries filling 248,000 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.
Gilenya (Fingolimod) costs an average of $5,738 per Medicare Part D claim, with total Medicare spending of $1423.0M 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 Gilenya (Fingolimod). Patent protection extends until 2027-09-22, 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 multiple sclerosis 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.
Gilenya is manufactured by Novartis. The FDA application number is NDA022527.
Gilenya (Fingolimod) is primarily prescribed for Multiple Sclerosis.
Medicare Part D spending on Gilenya has decreased -14.8% year over year. Total program spending reached $1423.0M in the latest reporting year.
Gilenya (Fingolimod) costs an average of $5,738 per Medicare Part D claim, with total Medicare spending of $1423.0M 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.