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

Retacrit (epoetin alfa-epbx) is a costly specialty biologic that many patients cannot afford without proper insurance coverage and financial support programs. As a prescribing provider, you have significant influence over how much your patients pay — through formulary selection, billing practices, prior authorization management, and proactive assistance program referrals. This guide covers everything you need to know.

Understanding Retacrit's Cost Landscape

Retacrit's cash price varies widely by vial strength and is not trivial:

• 2,000 Units/mL (10 mL): from approximately $228 per vial
• 10,000 Units/mL (10 mL): from approximately $1,112 per vial
• 40,000 Units/mL (1 mL): retail approximately $560 per vial

A patient receiving Retacrit 10,000 Units three times per week would use 3 vials per week — potentially exceeding $13,000 per month at full retail price. While most patients have insurance, cost access barriers remain real for the uninsured, underinsured, and those with high deductibles or coinsurance requirements.

Key Savings Resource #1: Pfizer Oncology Together Patient Assistance Program

Pfizer's Oncology Together program (also accessible via Pfizer RxPathways) is the primary manufacturer-sponsored resource for patients who cannot afford Retacrit. Key program details:

• Program name: Pfizer Oncology Together / Pfizer RxPathways
• Phone: 1-877-744-5675
• Website: pfizerrxpathways.com
• Eligibility: Primarily uninsured patients and those with limited income; certain insured and Medicare Part D patients may qualify under specific criteria
• Benefit: Eligible patients may receive Retacrit at no cost
• Provider role: Your signature is typically required on the application; your office can initiate the process on behalf of the patient

Key Savings Resource #2: Optimizing Medicare Part B Billing

For Medicare patients, how Retacrit is billed has a major impact on patient cost-sharing. Retacrit administered in a clinical setting is typically billed under Medicare Part B rather than Part D. Under Part B:

• HCPCS code Q5105: Injection, epoetin alfa-epbx, biosimilar, (Retacrit), for ESRD on dialysis, 100 units
• HCPCS code Q5106: For non-ESRD use, 1000 units
• Under Part B, Medicare pays 80% of the allowed amount; the patient pays 20% coinsurance after the annual deductible
• For dialysis patients, ESA costs are bundled into the ESRD prospective payment system — meaning the dialysis facility bears the drug cost risk, not the patient directly

Important: Retacrit dispensed at a specialty pharmacy and self-injected at home may fall under Part D pharmacy benefits. However, not all Part D plans cover Retacrit — check whether the plan covers it under the medical or pharmacy benefit before directing home-use patients to a specialty pharmacy.

Key Savings Resource #3: Commercial Insurance Optimization

Retacrit has become the preferred ESA on many commercial formularies due to its lower acquisition cost compared to Epogen and Procrit. This is important for providers to understand:

• When Retacrit is the preferred ESA, patient copays are lower than for non-preferred Epogen or Procrit
• Many plans — including UnitedHealthcare — require step therapy through Retacrit before Epogen or Procrit will be covered
• Always prescribe the formulary-preferred ESA unless there is a clinical reason not to — this can mean zero copay vs. significant out-of-pocket cost for your patient

Key Savings Resource #4: Prior Authorization Management

A lapsed prior authorization is one of the most common causes of unexpected patient cost exposure for Retacrit. Best practices for PA management in your practice:

• Track PA expiration dates in your EHR — most plans require renewal every 3–6 months for ESAs
• Submit PA renewal with updated labs (hemoglobin/hematocrit, ferritin, TSAT within 30 days) proactively — 4–6 weeks before expiration
• Document indication clearly: CKD stage, most recent eGFR, hemoglobin value, iron stores, and therapeutic goal
• When PA is denied, request peer-to-peer review — ESA denials based on hemoglobin threshold technicalities are frequently overturned on peer-to-peer

Additional Patient Support Resources

Beyond Pfizer's PAP and insurance optimization, refer eligible patients to:

• American Kidney Fund (kidneyfund.org): Copay assistance grants for dialysis and CKD patients who qualify based on income and insurance status
• CancerCare Co-Payment Assistance Foundation: For cancer patients receiving Retacrit for chemotherapy-induced anemia; can help cover cost-sharing
• NeedyMeds (needymeds.org): Comprehensive PAP database that includes Retacrit and disease-specific foundations
• State Medicaid: Patients who have lost commercial coverage or whose income has declined may qualify for Medicaid, which typically covers Retacrit with minimal cost-sharing

How medfinder Supports Your Patients' Access

Even with full insurance coverage and financial assistance secured, patients still need to find a pharmacy that has Retacrit in their required strength in stock. medfinder for providers calls specialty pharmacies on behalf of your patients to find which ones can fill the prescription — reducing the burden on your staff and ensuring patients don't miss doses while searching for supply.

The Bottom Line

As a provider, your prescribing choices, PA management, and proactive referrals to patient assistance programs directly affect how much your patients pay for Retacrit. Prefer the formulary-preferred product, keep PAs current, enroll eligible patients in Pfizer's PAP, and refer CKD patients to the American Kidney Fund. Share our patient-facing Retacrit savings guide with patients who need more detail. And for ongoing access support, consider recommending medfinder for providers to your practice team.