Cost Information for NEXPLANON

Figuring out what you might pay out-of-pocket for a prescription medicine can be confusing. What you pay will depend on many factors, including your insurance situation. At Merck, we believe that you should be better able to understand what you can expect to pay out of your own pocket for your prescription medicine.

The Affordable Care Act (ACA) covers one type of birth control from each of 18 FDA-approved categories of birth control for women without charging a co-payment or co-insurance even if you haven’t met your deductible. This coverage includes the arm implant, NEXPLANON. Some patients may still be responsible for other costs associated with the product. This could include fees associated with insertion and/or removal procedures.

The list price for one rod (for up to 3 years of continuous pregnancy prevention) of NEXPLANON is $934.82.*

Most women will not pay the list price, although it may have an impact on your out-of-pocket costs.** The amount you will pay depends on many factors including your insurance situation. The information below will help you better estimate what you may pay for your prescription medicine based on your insurance situation. For the actual out-of-pocket cost, talk to your insurance provider who knows the details of your plan if you have insurance or contact your health care provider’s office.

Choose an option below that best describes your insurance situation:

I have commercial insurance through an employer or private policy that covers NEXPLANON.

For patients with commercial insurance, 96% of patients paid no out-of-pocket costs for NEXPLANON. For those patients who did have out-of-pocket costs, 80% of patients paid between $5 and $899 for NEXPLANON.¹

¹IQVIA Nexplanon OOP Costs, October 2019. Based on an analysis of 2018 commercial, Medicare and Medicaid claims. Commissioned by Merck, Sharp & Dohme, a subsidiary of Merck & Co., Inc. IQVIA’s analysis is based on remittance data that provides claim payment information after medical claims have been processed by the patient’s medical insurer and assigned to primary payer channel. The data is limited to remittance transactions on medical claims collected by IQVIA and may not constitute a nationally representative sample. Please note that a patient’s cost may differ from the amounts depicted above.

I have coverage for NEXPLANON through Medicare

For patients with Medicare, 99.4% of patients paid no out-of-pocket costs for NEXPLANON. For those patients who did have out-of-pocket costs, 80% of patients paid between $25 and $887 for NEXPLANON.¹

¹IQVIA Nexplanon OOP Costs, October 2019. Based on an analysis of 2018 commercial, Medicare and Medicaid claims. Commissioned by Merck, Sharp & Dohme, a subsidiary of Merck & Co., Inc. IQVIA’s analysis is based on remittance data that provides claim payment information after medical claims have been processed by the patient’s medical insurer and assigned to primary payer channel. The data is limited to remittance transactions on medical claims collected by IQVIA and may not constitute a nationally representative sample. Please note that a patient’s cost may differ from the amounts depicted above.

I have coverage for NEXPLANON through Medicaid

For patients with Medicaid, 99.7% of patients paid no out-of-pocket costs for NEXPLANON. For those patients who did have out-of-pocket costs, 80% of patients paid between $1 and $899 for NEXPLANON.¹ To learn more about Medicaid in your state and find out if you’re eligible, visit www.medicaid.gov/medicaid-and-you/index.html

¹IQVIA Nexplanon OOP Costs, October 2019. Based on an analysis of 2018 commercial, Medicare and Medicaid claims. Commissioned by Merck, Sharp & Dohme, a subsidiary of Merck & Co., Inc. IQVIA’s analysis is based on remittance data that provides claim payment information after medical claims have been processed by the patient’s medical insurer and assigned to primary payer channel. The data is limited to remittance transactions on medical claims collected by IQVIA and may not constitute a nationally representative sample. Please note that a patient’s cost may differ from the amounts depicted above.

I don’t have insurance, or NEXPLANON is not covered by my insurance.

If you don’t have insurance coverage or if your insurance does not cover your treatment with NEXPLANON, you could pay an amount closer to the list price shown above, plus any additional charges depending on where you receive your medicine.

*The list price is current as of October 2019. The list price does not include other treatment-related costs, such as insertion and/or removal procedure fees.

** The out-of-pocket costs include the price patients paid for NEXPLANON.


 


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  • You should not use NEXPLANON if you are pregnant or think you may be pregnant; have or have had blood clots;
  • You should not use NEXPLANON if you are pregnant or think you may be pregnant; have or have had blood clots; have liver disease or a liver tumor; have unexplained vaginal bleeding; have breast cancer or any other cancer that is sensitive to progestin (a female hormone), now or in the past; or are allergic to anything in NEXPLANON.