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Why Zetia Costs $21.00 Per Claim
Zetia (Ezetimibe) is used to treat high cholesterol. According to CMS Medicare Part D spending data, the program spent $298.0M on this drug, covering 2,140,000 beneficiaries across 14,280,000 claims.
A generic version of this drug is available, which means lower-cost alternatives exist. Patients should ask their pharmacist about generic Ezetimibe or talk to their doctor about therapeutic alternatives that may cost less.
Spending on Zetia decreased by 38.7% year-over-year, likely due to generic competition reducing prices.
Price Breakdown
Drug Details
Frequently Asked Questions
Zetia (Ezetimibe) costs an average of $21.00 per claim based on Medicare Part D data. The estimated annual cost per patient is $139.00. Actual out-of-pocket costs depend on your insurance plan and pharmacy.
Zetia averages $21.00 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 Zetia reflects in our Medicare Part D average of $21.00 per claim. Switching to generic Ezetimibe typically reduces cost by 80-95%. 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 Zetia, but coverage varies by formulary tier. Insurers typically prefer generic Ezetimibe (Tier 1, lowest copay) over brand-name Zetia (Tier 2-3, higher copay). 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. Switching to generic Ezetimibe is the single biggest cost reducer if your prescriber is open to it.
Brand-name Zetia costs more than generic Ezetimibe primarily for marketing reasons — patients can request the brand from their doctor even when a chemically identical generic exists. The active ingredient and clinical effect are the same.
Yes, a generic version of Zetia (Ezetimibe) is available. Generic medications typically cost 80-95% less than brand-name drugs. Ask your pharmacist about generic Ezetimibe.
Medicare Part D spent $298.0M on Zetia, covering 2,140,000 beneficiaries across 14,280,000 claims. This makes it one of the tracked drugs in the Medicare spending dashboard.
Ask your pharmacist about generic Ezetimibe, which is typically much cheaper. 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.
Reading Zetia's Medicare Pricing
Zetia averages $21.00 per Part D claim, near the commodity end of the price spectrum — the range where generics and long-established molecules for high cholesterol sit. A low per-claim cost usually means robust generic competition or an old, cheaply-manufactured active ingredient (Ezetimibe). At this price the bigger driver of total Medicare spending is volume, not unit price.
Zetia accounts for $298.0M in Medicare Part D spending — a large line item built from 14,280,000 claims across 2,140,000 beneficiaries. Whether that total is driven more by price or by volume is the useful question: a high $21.00 average claim cost means price is the lever, a modest one means utilization is. Either way, a drug at this spending level is firmly on plan formulary committees' radar.
Because a generic version of Ezetimibe is on the market, the realistic savings path for Zetia is straightforward: the generic is therapeutically equivalent and typically costs a fraction of the brand. The friction is usually prescribing habit rather than availability — patients can ask the prescriber to write for the generic, and most plans already steer to it with a lower copay tier. That single switch usually beats coupons, assistance programs, and pharmacy shopping combined.
Every figure here comes from the CMS Medicare Part D Drug Spending dashboard, which reports what the program paid — not the cash price at a retail pharmacy and not a patient's out-of-pocket cost. List prices also overstate the real economics: manufacturers pay confidential rebates to pharmacy benefit managers, so the net price plans actually pay is often well below the sticker. Treat $21.00 as a consistent Medicare-program benchmark for Zetia, useful for comparing drugs on the same basis, rather than the price any one patient will see at the counter.
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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.