How to Help Your Patients Save Money on Ohtuvayre: A Provider's Guide to Savings Programs

At a wholesale acquisition cost (WAC) of approximately $35,400 annually — or about $2,950 per month — Ohtuvayre (ensifentrine) is one of the most expensive COPD medications on the market. For many of your patients, this price creates an immediate barrier between the prescription pad and actual treatment. As the prescribing provider, understanding the savings landscape is essential to helping your patients actually get the medication you've prescribed.

This guide covers every savings program and financial assistance pathway available for Ohtuvayre in 2026, with practical steps for your practice to implement at the point of care.

Program 1: Verona Pathway Plus Copay Assistance (Commercial Insurance)

The most impactful savings program for commercially insured patients is the Verona Pathway Plus copay assistance card. Eligible patients may pay as little as $0 per month.

Who qualifies: Patients with commercial insurance (employer-sponsored, marketplace/ACA plans, or private insurance). NOT available to Medicare, Medicaid, or other federal/state government program beneficiaries.

How to enroll at the point of prescribing: Submit the Verona Pathway Plus Prescription Form along with the Ohtuvayre prescription. Include front and back copies of the patient's insurance card. The copay card is transmitted directly to the specialty pharmacy.

Program contact: 1-833-372-8492, Monday–Friday, 8 AM–8 PM ET

Practice tip: Train your front desk or MA staff to submit the Pathway Plus enrollment form simultaneously with every Ohtuvayre prescription. Every commercially insured patient should be enrolled before leaving or immediately after the visit.

Program 2: Medicare Part B Coverage

For your Medicare patients, Ohtuvayre may be covered under Medicare Part B as a nebulizer medication (HCPCS code J7601). Medicare Part B covers 80% of the approved amount for covered drugs after the annual Part B deductible ($257 in 2025) is met.

For patients with Medicare Part B AND a Medigap supplemental plan, the Medigap plan typically covers the remaining 20% coinsurance — meaning Ohtuvayre may be 100% covered at no out-of-pocket cost to the patient. This is confirmed by Verona Pathway Plus as a potential outcome for patients with Part B + Supplemental coverage.

Documentation tip: When submitting clinical documentation for Medicare Part B coverage, include documentation that the patient has a nebulizer (or will be getting one) at home. Medicare Part B coverage of nebulizer drugs is linked to the durable medical equipment (DME) benefit.

Program 3: Medicare Part D — The $2,000 Cap Advantage

Starting in 2025, Medicare Part D implemented a $2,000 annual out-of-pocket cap for prescription drug costs. Once a patient reaches this cap, their Part D plan covers 100% of covered medications for the remainder of the benefit year. For a drug like Ohtuvayre, which would previously have pushed patients into high-cost territory, this cap is meaningful relief.

Additionally, the Medicare Prescription Payment Plan allows patients to spread their out-of-pocket costs evenly throughout the year instead of paying large amounts upfront — particularly helpful for patients whose costs are front-loaded in Q1.

Program 4: Medicare Extra Help / Low Income Subsidy

For Medicare patients with limited income and resources, the Low Income Subsidy (LIS) / Extra Help program substantially reduces Part D out-of-pocket costs, including copays, deductibles, and premiums. Screen all Medicare patients for potential Extra Help eligibility — especially those with COPD, who are frequently on fixed incomes.

Where to refer patients: Social Security Administration (SSA) at ssa.gov or 1-800-772-1213; or your local State Health Insurance Assistance Program (SHIP)

Program 5: Patient Assistance for Uninsured/Underinsured Patients

For patients who are uninsured, underinsured, or whose insurance plan does not cover Ohtuvayre, Verona Pathway Plus offers a patient assistance program that may provide the medication at reduced or no cost.

Eligibility: Typically based on income level and insurance status; documentation may be required

Contact: 1-833-372-8492; Verona Pathway Plus Care Coordinators will determine eligibility and assist with enrollment

Program 6: Bridge Supply During PA Review

Prior authorization for Ohtuvayre typically takes 2 to 4 weeks. For patients whose symptoms are severe, that wait can be clinically significant. Verona Pathway Plus may be able to provide a bridge supply of medication during the prior authorization review period in certain cases.

Ask your Verona Pathway Plus rep or Care Coordinator about bridge supply eligibility when enrolling patients with high symptom burden or those who have been waiting for an extended period.

Handling Coverage Denials: Strategies That Work

When commercial or Medicare PA requests are denied, don't accept the first no as final. Here's what to do:

File a peer-to-peer review. Request a peer-to-peer call with the plan's medical director. Present the clinical rationale directly, referencing ENHANCE trial outcomes and the 2025 GOLD guidelines' acknowledgment of Ohtuvayre.

Submit a formal appeal with a Letter of Medical Necessity (LMN). Document: (1) severity of COPD with spirometry data, (2) inadequate response to prior medications, (3) steroid-free benefit for patients where ICS is problematic, (4) FEV1 improvement data from ENHANCE trials.

Reference ICER context. While ICER issued an affordability alert, their clinical effectiveness assessment still concluded Ohtuvayre is effective. Use the effectiveness data to counter formulary non-coverage arguments.

Engage Verona Pathway Plus for appeal support. The Pathway Plus team has experience supporting prior authorization appeals and can provide clinical documentation resources.

Quick Reference: Savings Programs by Patient Type

Commercially insured: Verona Pathway Plus copay card → as little as $0/month

Medicare Part B + Medigap: Potentially $0 out of pocket (Medicare 80% + Medigap 20%)

Medicare Part D (2025+): $2,000 annual OOP cap; Medicare Prescription Payment Plan available

Low income Medicare: Extra Help / LIS program — reduced copays and deductibles

Uninsured/underinsured: Verona Pathway Plus patient assistance program — income-based eligibility

Supporting Patients After Prescription: medfinder

Even after financial barriers are resolved, patients still need to locate a specialty pharmacy that has Ohtuvayre in stock. Recommending medfinder for providers can help: patients enter their medication and location, medfinder calls pharmacies on their behalf, and texts them which ones can fill the prescription. This saves COPD patients — who often have limited energy and breath for phone calls — significant frustration.

For a patient-facing version of this savings guide, see: How to Save Money on Ohtuvayre in 2026.