Cystic Fibrosis Drug Costs With Medicare
Compare 2 cystic fibrosis drug prices under Medicare Part D, averaging $14,842.50 per claim. Prices range from $13,935.00 (Trikafta) to $15,750.00 (Kalydeco) per prescription. 2 of 2 drugs have FDA-approved generics that cost 30-80% less.
Key Facts: Cystic Fibrosis Drug Costs
- Cheapest drug
- Trikafta ($13,935.00)
- Most expensive
- Kalydeco ($15,750.00)
- Medicare Part D avg
- $14,842.50/claim
- Generics available
- 2 of 2
- Total Medicare spend
- $4.0B/yr
- Brand-only drugs
- 0
Source: CMS Medicare Part D Spending, latest reporting year. Costs reflect plan-paid amounts, not patient out-of-pocket.
Cystic Fibrosis Drug Price Comparison
All 2 cystic fibrosis drugs tracked in Medicare Part D, sorted from cheapest to most expensive. Click any drug for Medicare coverage details, generic timelines, and savings options.
| Drug | Generic Name | Medicare Avg/Claim | Generic Available? |
|---|---|---|---|
| Trikafta | Elexacaftor/Tezacaftor/Ivacaftor | $13,935.00 | Yes |
| Kalydeco | Ivacaftor | $15,750.00 | Yes |
Medicare Part D Coverage for Cystic Fibrosis Drugs
All 2 cystic fibrosis drugs in this comparison are dispensed under Medicare Part D. Total Medicare spending reached $4.0B in the latest reporting year, averaging $14,842.50 per prescription fill.
Your out-of-pocket cost depends on three factors: (1) your plan's formulary tier — generics typically land on Tier 1 ($0-$10 copay), preferred brands on Tier 2 ($30-$50), and specialty drugs on Tier 4-5 (often 25-33% coinsurance); (2) your deductible status — most plans require you to meet up to a $590 deductible before copays apply; (3) the coverage phase — initial coverage, coverage gap, or catastrophic. As of 2025, Medicare Part D caps total annual out-of-pocket at $2,000 under the Inflation Reduction Act.
The 2 drugs with generic availability are usually the most cost-effective starting point — ask your prescriber whether a generic substitution is clinically appropriate.
Drug costs vary dramatically within this category. Kalydeco (Ivacaftor) at $15,750.00 per claim is 1x more expensive than Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) at $13,935.00 — yet both treat cystic fibrosis. Therapeutic substitution within the same drug class is often the single biggest savings lever, and it requires only a prescriber conversation, not a plan change.
Frequently Asked Questions
Medicare Part D pays an average of $14,842.50 per claim for cystic fibrosis medications across 2 tracked drugs. Patient out-of-pocket costs depend on your plan's formulary tier, deductible, and whether you've reached the catastrophic coverage phase. Most cystic fibrosis drugs fall on Tier 2 (preferred brand) or Tier 3 (non-preferred brand) of standard Medicare Part D formularies.
The least expensive cystic fibrosis medication is Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) at $13,935.00 per Medicare Part D claim. A generic version is FDA-approved and available — ask your pharmacist about substitution to lower copays further.
Yes. All 2 cystic fibrosis drugs tracked here appear in Medicare Part D claims data, meaning they are dispensed under Part D plans. Coverage details — formulary tier, prior authorization requirements, step therapy — vary by plan. Check your plan's formulary or call 1-800-MEDICARE before filling.
Yes, 2 of 2 cystic fibrosis drugs have FDA-approved generic alternatives. Generics contain the same active ingredient and meet bioequivalence standards, but typically cost 30-80% less. On Medicare Part D, generics usually fall on Tier 1 with the lowest copay.
Three primary strategies: (1) Switch to a generic if available — Tier 1 generics typically cost under $10 per fill on Medicare Part D; (2) Use manufacturer copay assistance for brand-name drugs (commercial insurance only — Medicare beneficiaries can apply for patient assistance foundations like NeedyMeds or the PAN Foundation); (3) Compare cash prices using GoodRx, SingleCare, or Mark Cuban's Cost Plus Drugs — sometimes cash pay beats your Part D copay. Talk to your doctor about therapeutic alternatives in the same drug class.
Related Conditions
Cost per claim is the average plan-paid amount per prescription fill under Medicare Part D. Patient out-of-pocket varies by formulary tier and deductible status. Generic availability is based on FDA Orange Book data.
Source: CMS Medicare Part D Spending, 2026.