How Much Does Trikafta Cost With Medicare?
Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) costs an average of $13,935 per Medicare Part D claim, with total Medicare spending of $3456.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Key Facts: Trikafta Cost
- Medicare Part D avg
- $13,935/claim
- Likely Part D tier
- Tier 4-5 (specialty)
- Annual cost/patient
- $192,000
- Generic available
- Yes — Elexacaftor/Tezacaftor/Ivacaftor
- Manufacturer
- Vertex
- Treats
- Cystic Fibrosis
- YoY price change
- +18.4%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Trikafta Medicare Coverage & Out-of-Pocket Cost
Trikafta is covered under Medicare Part D, with the program paying an average of $13,935 per prescription fill. Trikafta 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 Elexacaftor/Tezacaftor/Ivacaftor 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 Trikafta. 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.
Trikafta is manufactured by Vertex and prescribed primarily for Cystic Fibrosis. In the most recent Medicare Part D data, 248,000 claims were filed for 18,000 unique beneficiaries, at an average cost of $13,935 per claim. Average annual cost per beneficiary is $192,000.
Year over year, Medicare spending on Trikafta has increased by +18.4%. Because a generic version of Elexacaftor/Tezacaftor/Ivacaftor 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 | $13,935 |
| Total Medicare Spending | $3456.0M |
| Total Claims | 248,000 |
| Beneficiaries | 18,000 |
| Generic Available | Yes |
| Year-Over-Year Change | +18.4% |
Other Drugs for Cystic Fibrosis
Frequently Asked Questions
Medicare Part D pays an average of $13,935 per claim for Trikafta. Trikafta 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. Trikafta appears in Medicare Part D claims data, with 18,000 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.
Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) costs an average of $13,935 per Medicare Part D claim, with total Medicare spending of $3456.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Yes. A generic version of Elexacaftor/Tezacaftor/Ivacaftor is available, which typically costs 80-95% less than brand-name Trikafta. 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 cystic fibrosis 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.
Trikafta is manufactured by Vertex. The FDA application number is BLA125057.
Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) is primarily prescribed for Cystic Fibrosis.
Medicare Part D spending on Trikafta has increased +18.4% year over year. Total program spending reached $3456.0M in the latest reporting year.
Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) costs an average of $13,935 per Medicare Part D claim, with total Medicare spending of $3456.0M 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.