How Much Does Opsumit Cost With Medicare?
Opsumit (Macitentan) costs an average of $10,186 per Medicare Part D claim, with total Medicare spending of $876.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Key Facts: Opsumit Cost
- Medicare Part D avg
- $10,186/claim
- Likely Part D tier
- Tier 4-5 (specialty)
- Annual cost/patient
- $104,286
- Generic available
- Yes — Macitentan
- Manufacturer
- Janssen
- Treats
- Pulmonary Hypertension
- YoY price change
- +4.6%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Opsumit Medicare Coverage & Out-of-Pocket Cost
Opsumit is covered under Medicare Part D, with the program paying an average of $10,186 per prescription fill. Opsumit 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.
Because generic Macitentan 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 Opsumit. 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.
Opsumit is manufactured by Janssen and prescribed primarily for Pulmonary Hypertension. In the most recent Medicare Part D data, 86,000 claims were filed for 8,400 unique beneficiaries, at an average cost of $10,186 per claim. Average annual cost per beneficiary is $104,286.
Year over year, Medicare spending on Opsumit has increased by +4.6%. Because a generic version of Macitentan 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 | $10,186 |
| Total Medicare Spending | $876.0M |
| Total Claims | 86,000 |
| Beneficiaries | 8,400 |
| Generic Available | Yes |
| Year-Over-Year Change | +4.6% |
Other Drugs for Pulmonary Hypertension
Frequently Asked Questions
Medicare Part D pays an average of $10,186 per claim for Opsumit. Opsumit 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. Opsumit appears in Medicare Part D claims data, with 8,400 beneficiaries filling 86,000 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.
Opsumit (Macitentan) costs an average of $10,186 per Medicare Part D claim, with total Medicare spending of $876.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Yes. A generic version of Macitentan is available, which typically costs 80-95% less than brand-name Opsumit. 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 pulmonary hypertension 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.
Opsumit is manufactured by Janssen. The FDA application number is BLA125057.
Opsumit (Macitentan) is primarily prescribed for Pulmonary Hypertension.
Medicare Part D spending on Opsumit has increased +4.6% year over year. Total program spending reached $876.0M in the latest reporting year.
Opsumit (Macitentan) costs an average of $10,186 per Medicare Part D claim, with total Medicare spending of $876.0M 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.
A practical caveat: the headline answer above reflects the most recent CMS Medicare Part D Drug Spending data vintage; underlying data is often revised for months after first publication, and the right reference for any specific decision is whichever vintage is current at the time of the decision. The as-of date is stamped on every page.
Source: CMS Medicare Part D Spending, 2026.