Linzess (linaclotide) is a prescription medication commonly used to treat irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). If your doctor has recommended Linzess, you may be wondering: Is Linzess covered by insurance? In this guide, we’ll break down coverage details, costs, and what to expect with different insurance plans.
Is Linzess Covered by Insurance?
In most cases, Linzess is covered by insurance, but coverage can vary depending on your specific health plan, provider, and diagnosis. Linzess is typically listed as a tier 2 or tier 3 medication, meaning you may have a copay or coinsurance requirement.
Factors Affecting Coverage
- Insurance provider: Private insurers like Aetna, Cigna, Blue Cross Blue Shield, and UnitedHealthcare often cover Linzess, though the out-of-pocket cost may vary.
- Medicare and Medicaid: Many Medicare Part D plans and Medicaid programs cover Linzess, though prior authorization may be required.
- Diagnosis and medical necessity: Insurers are more likely to approve coverage if Linzess is prescribed for FDA-approved uses like IBS-C or CIC.
Do Most Insurances Cover Linzess?
Coverage Rates by Plan Type
- Private Insurance (Employer-Sponsored or Individual Plans):
Most plans cover Linzess, especially if prescribed for an approved condition. However, patients may need to meet step therapy requirements, meaning they must try cheaper medications first. - Medicare Part D:
Many Medicare drug plans include Linzess in their formularies, but coverage may depend on the plan’s tier structure and formulary rules. Some plans may also require prior authorization. - Medicaid:
Coverage varies by state, but many state Medicaid programs cover Linzess, especially if the patient has tried and failed other treatment options.
How to Check Your Coverage
- Review your plan’s formulary list.
- Contact your insurance provider directly.
- Ask your pharmacist for assistance with pricing and coverage options.
What Diagnosis Will Cover Linzess?
Insurance companies typically approve Linzess for these FDA-approved diagnoses:
- Irritable Bowel Syndrome with Constipation (IBS-C) – For adults who suffer from abdominal pain and chronic constipation.
- Chronic Idiopathic Constipation (CIC) – For adults with persistent constipation that has no identifiable cause.
Off-Label Uses
In some cases, doctors may prescribe Linzess for off-label uses, such as opioid-induced constipation. However, insurance coverage for off-label uses is less common and often requires additional medical documentation or prior authorization.
How Much Does a 30-Day Supply of Linzess Cost?
The cost of a 30-day supply of Linzess can vary widely depending on your insurance plan, pharmacy, and dosage (72 mcg, 145 mcg, or 290 mcg).
Average Cost with Insurance
With insurance coverage, your copay for Linzess could range from:
- $30 to $75 per month for patients with commercial insurance.
- $10 to $45 per month for Medicare Part D enrollees (depending on the phase of coverage — deductible, initial coverage, donut hole, etc.).
Cost Without Insurance
Without insurance, the list price for a 30-day supply of Linzess is approximately:
- $500 to $550 per month (depending on dosage and pharmacy).
How Much Is Linzess Without Insurance at Walgreens?
At Walgreens, the cash price for Linzess typically falls around:
- $500 to $530 for a 30-day supply.
- Prices may vary by location, promotions, and available manufacturer coupons.
Cost-Saving Options
If you’re uninsured or underinsured, consider:
- Manufacturer Coupons – The Linzess Savings Program may offer eligible patients discounts.
- Pharmacy Discount Cards – Programs like GoodRx or SingleCare can reduce the cost by up to 80%.
- Patient Assistance Programs – Available for qualified individuals with financial need.
Final Thoughts
So, is Linzess covered by insurance? In most cases, yes — but your exact out-of-pocket costs, requirements, and coverage restrictions depend on your plan. Whether you have private insurance, Medicare, or Medicaid, you can work with your doctor and pharmacist to ensure you receive the most affordable treatment option.
Quick Tips for Savings
- Check for coupons or manufacturer savings cards.
- Use pharmacy discount apps to compare prices.
- If Linzess isn’t covered, ask your doctor about alternative medications.
FAQs
Q: Can you get Linzess for free?
A: Eligible patients with financial hardship may qualify for patient assistance programs from the manufacturer.
Q: Is there a generic version of Linzess?
A: Currently, there is no generic equivalent for Linzess in the U.S., so prices remain high.
Q: How do I know if my plan covers Linzess?
A: Contact your insurance provider or review your plan’s drug formulary online.
