How Much Does Simponi Cost With Medicare?
Simponi (Golimumab) costs an average of $4,036 per Medicare Part D claim, with total Medicare spending of $678.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Key Facts: Simponi Cost
- Medicare Part D avg
- $4,036/claim
- Likely Part D tier
- Tier 4-5 (specialty)
- Annual cost/patient
- $37,667
- Generic available
- Yes — Golimumab
- Manufacturer
- Janssen
- Treats
- Autoimmune Diseases
- YoY price change
- -6.4%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Simponi Medicare Coverage & Out-of-Pocket Cost
Simponi is covered under Medicare Part D, with the program paying an average of $4,036 per prescription fill. Simponi 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 Golimumab 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 Simponi. 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.
Simponi is manufactured by Janssen and prescribed primarily for Autoimmune Diseases. In the most recent Medicare Part D data, 168,000 claims were filed for 18,000 unique beneficiaries, at an average cost of $4,036 per claim. Average annual cost per beneficiary is $37,667.
Year over year, Medicare spending on Simponi has decreased by -6.4%. Because a generic version of Golimumab 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 | $4,036 |
| Total Medicare Spending | $678.0M |
| Total Claims | 168,000 |
| Beneficiaries | 18,000 |
| Generic Available | Yes |
| Year-Over-Year Change | -6.4% |
Other Drugs for Autoimmune Diseases
Frequently Asked Questions
Medicare Part D pays an average of $4,036 per claim for Simponi. Simponi 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. Simponi appears in Medicare Part D claims data, with 18,000 beneficiaries filling 168,000 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.
Simponi (Golimumab) costs an average of $4,036 per Medicare Part D claim, with total Medicare spending of $678.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Yes. A generic version of Golimumab is available, which typically costs 80-95% less than brand-name Simponi. 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 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.
Simponi is manufactured by Janssen. The FDA application number is BLA125057.
Simponi (Golimumab) is primarily prescribed for Autoimmune Diseases.
Medicare Part D spending on Simponi has decreased -6.4% year over year. Total program spending reached $678.0M in the latest reporting year.
Simponi (Golimumab) costs an average of $4,036 per Medicare Part D claim, with total Medicare spending of $678.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
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.