Prevnar 20

Introduction

Written by Kirstyn Hill, PharmD, MPH
Medically reviewed by Philip Ngo, PharmD
Updated on July 11, 2024

Prevnar 20 is a brand-name vaccine that helps prevent Streptococcus pneumoniae infections. Prevnar 20 is not available in a biosimilar version. The cost of Prevnar 20 with or without insurance can depend on several factors. It might be lowered by using a coupon.

Specifically, the Food and Drug Administration (FDA) has approved Prevnar 20 to help prevent certain bacterial infections caused by particular strains of Streptococcus pneumoniae, including:

• invasive disease in adults and children ages 6 weeks and older
• otitis media in adults and children ages 6 weeks to 5 years
• pneumonia in individuals ages 18 years and older

Read on to learn about Prevnar 20 and its cost. You’ll also find available coupons and suggestions for ways to save on your prescription. If you’d like more information about Prevnar 20, including its uses, talk with your doctor or pharmacist.

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Cost of Prevnar 20

Like other medications, the cost of Prevnar 20 can vary. Certain factors may affect its price, such as:

• your insurance plan, if you have coverage
• the pharmacy where you receive the vaccine
• the cost to visit a healthcare professional to receive the dose(s) of Prevnar 20

To find out how much Prevnar 20 costs, ask your doctor, pharmacist, or insurance provider. They may be able to suggest ways to save money on your prescription, including those described in this article. To find out what you’d pay using savings coupons, read the “Coupons for Prevnar 20” section.

Coupons for Prevnar 20

Prescription drug coupons can help you save money by lowering the cost of Prevnar 20. The Optum Perks coupons above can provide significant savings on your prescription costs.

Note: Optum Perks coupons cannot be used with any insurance copays or benefits.

Available app for coupons

To make finding and using these coupons easier, you can download the Optum Perks app. To learn more about this prescription discount app, see this article.

Insurance and other considerations for Prevnar 20

Here’s a list of things to consider about the cost of prescription drugs:

• Prior authorization: If you have prescription drug insurance, your insurance company may require prior authorization before it covers the cost of Prevnar 20. In this case, your doctor will communicate with your insurance company regarding your prescription for Prevnar 20. The insurance company will decide whether to cover the medication. If a drug requires prior authorization and you receive Prevnar 20 without this, you may have to pay the full price of the drug.
• Insurance coverage: Even if your policy has prescription drug coverage, the price of Prevnar 20 may instead be billed through your medical coverage. This is because a doctor or another healthcare professional gives the dose(s) of Prevnar 20. The cost of your dose(s) will depend on your specific insurance plan and whether you receive the dose(s) at a pharmacy, your doctor’s clinic, or a hospital. If you have questions about this process, contact your doctor or your insurance provider.
• Savings accounts: If you’re eligible for a health savings account (HSA) or a flexible spending account (FSA), you can likely use funds from these accounts to pay for your prescription or over-the-counter (OTC) medications and copays. This includes copays for visits to the doctor’s office, clinic, or hospital to receive the dose(s) of Prevnar 20. HSA and FSA plans help people save money by using pretax dollars to pay for eligible healthcare expenses, such as prescription and OTC drugs. To learn more about whether you’re eligible for these savings accounts and how to use them, talk with your insurance provider or employer.

If you have questions about any of these considerations, ask your doctor or pharmacist. Or contact your insurance company and talk with a representative.

If you don’t have a health insurance plan, let your doctor or pharmacist know. They may suggest online pharmacy options you could use. You can also ask them about ways to obtain health insurance coverage.

Brand names vs. biosimilars

Prevnar 20 is a brand-name biologic medication. (A biologic drug is sourced from living organisms.) Prevnar 20 is not available in a biosimilar version.

How biosimilars and generics compare

A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). A generic medication is an identical copy of the active ingredient in a brand-name medication. (An active ingredient is what makes a medication work.)

Biosimilars tend to cost less than brand-name medications. Like generics, biosimilars are thought to be as safe and effective as the brand-name drug version.

Talk with your doctor or pharmacist if you have questions about biosimilar and brand-name medications.

Why costs are different for brand-name biologic drugs vs. biosimilar drugs

Biologic drugs can be expensive because of the studies needed to test how safe and effective they are.

Makers of a biologic drug can patent and sell their drug for up to 12 years. When the patent for a brand-name biologic drug expires, other drugmakers can make and sell biosimilar versions.

This competition may help keep the costs of biosimilar medications lower. Also, biosimilar medications are very similar to biologic drugs. So they don’t require the same testing, which may be costly.

If you’d like to know more about the cost differences between brand-name biologic drugs and biosimilar drugs, talk with your doctor or pharmacist.

Common questions about Prevnar 20 and cost

Here are some common questions and answers about Prevnar 20.

Is Prevnar 20 covered by Medicare?

Yes, Prevnar 20 is most likely covered by your Medicare drug plan. Pneumococcal vaccines are usually covered by Medicare Part B. Medicare Part B is the part of Medicare that provides medical insurance.

If you’d like to know more about whether Prevnar 20 is covered by Medicare, talk with your insurance provider, doctor, or pharmacist.

How much does Prevnar 20 cost?

It depends. The amount you pay for Prevnar 20 is affected by several factors. This includes whether you have insurance, whether the vaccine is covered by your insurance, and whether you receive Prevnar 20 at a pharmacy, clinic, or hospital.

To find out how much you can expect to pay for Prevnar 20, contact your insurance provider, doctor, or pharmacist.

Is Prevnar 20 covered by insurance?

Yes, Prevnar 20 is most likely covered by insurance. Most private insurance companies and all Health Insurance Marketplace plans are required to cover certain preventive health services. Immunizations are considered preventive health measures, and Prevnar 20 may be covered based on your specific plan.

If you’d like to know more about whether Prevnar 20 is covered by your insurance, talk with your insurance provider, doctor, or pharmacist.

Resources

• Food and Drug Administration. (2024). Purple Book: Database of licensed biological products. https://purplebooksearch.fda.gov
• How to pay for adult vaccines. (2023). https://www.cdc.gov/vaccines/adults/pay-for-vaccines.html
• Prevnar 20 (pneumococcal 20-valent conjugate vaccine), suspension for intramuscular injection. (2024). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/3a33a84f-166b-4698-90b9-d79265234ae7/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.