Why Gilenya Costs $5,738.00 Per Claim
Gilenya (Fingolimod) is used to treat multiple sclerosis. According to CMS Medicare Part D spending data, the program spent $1.4B on this drug, covering 22,000 beneficiaries across 248,000 claims.
This drug is currently protected by patents expiring Sep 22, 2027. Until patent protection ends, no generic version can enter the market, which limits price competition. Once generics become available, the price typically drops 80-95%.
Spending on Gilenya decreased by 14.8% year-over-year, possibly due to declining utilization or formulary changes.
Price Breakdown
Drug Details
Frequently Asked Questions
Gilenya (Fingolimod) costs an average of $5,738.00 per claim based on Medicare Part D data. The estimated annual cost per patient is $64,682.00. Actual out-of-pocket costs depend on your insurance plan and pharmacy.
Gilenya averages $5,738.00 per Medicare Part D claim — roughly equivalent to a 30-day supply for most patients on standard dosing. Without insurance, expect higher cash-pay prices unless you use a discount program (GoodRx, SingleCare, manufacturer copay assistance). With Medicare or commercial insurance, your out-of-pocket cost depends on your plan's formulary tier and deductible status.
A typical 30-day supply of Gilenya reflects in our Medicare Part D average of $5,738.00 per claim. No generic is available yet, so cost remains at brand-name pricing. Cash-pay prices vary by pharmacy — comparison shopping (or using GoodRx coupons) often saves 20-50% off the listed price.
Most commercial insurance plans and Medicare Part D plans cover Gilenya, but coverage varies by formulary tier. Gilenya is often Tier 2 or Tier 3 on most formularies, meaning a higher copay than generic alternatives. Some plans require prior authorization or step therapy. Check your plan's formulary or call the number on your insurance card to confirm.
Several options for cash-pay patients: (1) Manufacturer patient assistance programs — the manufacturer may offer copay cards or free-drug programs for income-qualified patients; (2) Discount programs like GoodRx, SingleCare, or RxSaver typically save 20-80% off the cash price; (3) Mark Cuban's Cost Plus Drugs offers transparent generic pricing if a generic is available; (4) 340B-eligible community health centers offer drugs at federally negotiated discounts. Patient assistance programs are the primary affordability path while no generic is available.
Gilenya is still under patent protection until Sep 22, 2027, giving the manufacturer market exclusivity. Once the patent expires, generics enter the market and prices typically fall 80-95% within 1-2 years.
No, Gilenya is currently brand-only. Patent protection expires Sep 22, 2027, after which generic versions may enter the market.
Medicare Part D spent $1.4B on Gilenya, covering 22,000 beneficiaries across 248,000 claims. This makes it one of the tracked drugs in the Medicare spending dashboard.
Check manufacturer patient assistance programs for potential savings. You can also compare prices at different pharmacies, use prescription discount programs (GoodRx, SingleCare, Cost Plus Drugs), or ask your doctor about therapeutic alternatives in the same drug class.
this entity is one of the data points covered by this site’s U.S. Medicare prescription-drug pricing dataset. The detail above comes directly from CMS Medicare Part D Drug Spending data; the context that follows situates the headline numbers against the broader distribution across U.S. prescription drugs.
The methodology behind every numeric value on this page is publicly documented on the CMS Medicare Part D Drug Spending data portal and described in detail on this site’s methodology page. Refresh cadence varies by underlying series; the page surfaces the as-of date for each number so readers can trace any figure back to the source release.
For readers using this page as a decision input, the related-entity pages elsewhere on the site provide the comparison set. The most useful comparison for this entity is typically a peer within U.S. prescription drugs with similar size, similar exposure, or similar geography — not the national-level summary alone.
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Cost data reflects Medicare Part D spending and may not represent retail pharmacy prices. Average cost per claim represents the total drug cost (not patient out-of-pocket) divided by total claims.