Finasteride is a prescription medication used to treat two distinct conditions: benign prostatic hyperplasia (BPH), or an enlarged prostate, and androgenetic alopecia, commonly known as male pattern hair loss. The cost of Finasteride with insurance is highly variable, depending almost entirely on the medical condition being treated and the specifics of your insurance plan’s design. The final price can range from a minimal copayment to hundreds of dollars per month, making it crucial to understand the rules your insurer applies to this drug.
Insurance Coverage Variables
Insurance coverage for Finasteride is primarily determined by the drug’s approved indication and dosage. The 5-milligram (mg) tablet, originally sold under the brand name Proscar, is prescribed for BPH. Since BPH is considered a medical condition, the 5mg dosage is typically classified as medically necessary and is often covered by most commercial, Medicare, and Medicaid prescription drug plans.
The 1mg tablet, originally branded as Propecia, is used to treat male pattern hair loss. This condition is often categorized as cosmetic by insurance companies, meaning the 1mg dose is frequently excluded from coverage entirely. If the drug is covered, it is often placed on a high-cost tier of the insurance company’s formulary.
Generic medications are usually placed on a plan’s lowest cost-sharing tier, often Tier 1, while brand-name drugs fall onto higher tiers with greater out-of-pocket costs. Generic Finasteride is available for both the 1mg and 5mg dosages, but even the generic 1mg version for hair loss may be excluded or subject to higher copayments because of its cosmetic designation. If coverage is denied, a patient or prescriber may request a formulary exception by submitting a letter of medical necessity, though this process is challenging for hair loss treatment.
Factors Determining Your Final Out-of-Pocket Cost
Even when Finasteride is covered, the amount a patient pays is controlled by their specific plan’s financial structure. The deductible is the initial amount a patient must pay out-of-pocket for covered healthcare services, including prescriptions, before the insurance company begins to share costs. If the deductible has not been met, the patient will pay the full, negotiated price of the drug, even if it is on the formulary.
Once the deductible is satisfied, cost-sharing transitions to either a copayment or coinsurance. A copayment is a fixed dollar amount the patient pays for a prescription, such as $10 or $40, depending on the drug’s tier. Coinsurance is a percentage of the total cost of the drug, meaning the amount paid fluctuates based on the drug’s price.
For a drug placed on a higher formulary tier, the copayment or coinsurance will be greater than for a Tier 1 generic medication. The out-of-pocket cost will also be affected by whether the patient has reached their annual out-of-pocket maximum, at which point the insurance plan covers all subsequent covered costs for the remainder of the year.
Non-Insurance Costs and Cash Prices
For patients without insurance coverage for the 1mg dose or those who have not met a high deductible, the cash price of Finasteride serves as the baseline expense. The average retail price for a 90-day supply of generic 1mg Finasteride tablets can be around $247 without any discounts. A 90-day supply of the 5mg tablets typically costs a similar amount at retail price.
The brand-name versions, Propecia (1mg) and Proscar (5mg), are substantially more expensive than the generic formulation. Cash prices are the full amount paid to the pharmacy before any insurance processing or application of outside discounts. This is the price a patient pays if their insurance plan denies coverage outright, which is common for the cosmetic 1mg indication.
Options for Reducing Finasteride Costs
Several strategies exist to lower the final out-of-pocket cost for Finasteride, especially for the 1mg dose used for hair loss. Generic Finasteride is the most economical choice compared to the brand-name versions, Propecia and Proscar. Switching to the generic can immediately reduce the price paid, whether paying a copayment or the full cash price.
A common cost-saving measure is the practice of “pill-splitting,” where a patient is prescribed the 5mg tablet and instructed by their physician to cut it into four pieces, resulting in a daily dose of 1.25mg. Since the 5mg tablet is often covered by insurance and costs only slightly more than the 1mg tablet, this method can reduce the cost per daily dose significantly. This technique saves money even when paying the cash price, as the 5mg tablet is not priced five times higher than the 1mg tablet.
Another effective method for reducing the price is the use of pharmacy discount cards and coupons offered by services like GoodRx or SingleCare. These programs can lower the cash price to as little as $2.00 for a 30-day supply of generic Finasteride, which may be cheaper than an insurance copayment, especially if the drug is on a high tier. Patients should always compare the discount card price to their insurance copayment before filling the prescription.