Cost Is One of the Biggest Barriers to Brexafemme Adherence

You've determined that Brexafemme (Ibrexafungerp) is the right treatment for your patient's vulvovaginal candidiasis or recurrent VVC. But when they get to the pharmacy and see the price tag — $450 to $600 for a single treatment course — there's a real chance they'll walk away without filling the prescription.

Cost-related non-adherence is a well-documented problem across specialty medications, and Brexafemme is no exception. As a provider, you have more tools than you might think to help patients access this medication at a price they can manage. This guide walks through the savings programs, discount options, and conversation strategies that can make a difference.

What Patients Are Actually Paying

Understanding the cost landscape helps you anticipate patient concerns and proactively address them:

• Cash price (no insurance): $450–$600 for 4 tablets (one treatment course of 600 mg total)
• Commercially insured patients: Copays vary widely by plan. Many commercial insurers cover Brexafemme but may require prior authorization or step therapy (typically a trial of Fluconazole first). Copays for covered patients range from $30 to $150+ depending on formulary tier.
• Medicare Part D: Coverage varies by plan. The $2,000 annual out-of-pocket cap (effective as of 2025) may help limit total costs for Medicare beneficiaries who take multiple medications.
• Uninsured patients: Face the full cash price, which is often prohibitive.

For patients on RVVC maintenance therapy (one-day dosing monthly for 6 months), the total cost can reach $2,700–$3,600 without assistance — a significant financial burden.

Manufacturer Savings Programs

The Brexafemme copay assistance program is the most impactful tool for commercially insured patients:

• Eligible commercially insured patients may pay as little as $30 per prescription
• The program covers the difference between the patient's copay and $30, up to a maximum benefit
• Not available for patients on government insurance (Medicare, Medicaid, Tricare, VA) — this is a federal requirement, not a program limitation

How to Help Patients Access It

1. Mention the copay card at the time of prescribing — don't assume patients will find it on their own
2. Direct patients to the manufacturer's website or provide printed copay card information if available in your office
3. Have your staff help patients enroll before they leave the office, if possible
4. Note the copay card in the patient's chart so pharmacy staff can apply it at fill time

Coupon and Discount Cards

For patients who don't qualify for the manufacturer's program — or who want to compare prices — third-party discount cards can sometimes help:

• GoodRx — Shows cash prices at nearby pharmacies and offers coupons that may reduce out-of-pocket cost
• SingleCare — Similar pharmacy discount card program
• RxSaver — Price comparison tool with downloadable coupons
• BuzzRx, Optum Perks, and others — Various discount platforms that negotiate reduced rates with pharmacies

Important caveats for your patients:

• Discount cards cannot be combined with insurance — patients use one or the other at the pharmacy counter
• Savings vary significantly by pharmacy — prices can differ by hundreds of dollars between locations
• These tools work best for cash-pay or underinsured patients

For a comprehensive list of patient-facing savings options, you can direct patients to our guide on how to save money on Brexafemme.

Patient Assistance Programs

For uninsured or underinsured patients who cannot afford Brexafemme at any available price:

• Scynexis patient assistance — May be available for qualifying patients. Eligibility typically requires demonstrated financial need and lack of adequate insurance coverage.
• NeedyMeds (needymeds.org) — Comprehensive database of patient assistance programs, coupons, and discount cards
• RxAssist (rxassist.org) — Directory of pharmaceutical company patient assistance programs
• RxHope (rxhope.com) — Connects patients with manufacturer assistance programs

As a provider, you can expedite the process by:

• Having your office complete the provider portion of assistance applications
• Keeping blank PAP (Patient Assistance Program) forms on hand for commonly prescribed specialty medications
• Designating a staff member to manage PAP applications and follow up on approvals

Generic Alternatives and Therapeutic Substitution

As of 2026, there is no generic version of Brexafemme (Ibrexafungerp). When cost is the primary barrier, consider whether a therapeutic alternative could meet the patient's clinical needs:

First-Line Alternative: Fluconazole (Diflucan)

• Cost: $4–$15 (generic widely available)
• Route: Oral, single 150 mg dose for uncomplicated VVC
• Considerations: First-line for most patients. If the patient has already failed Fluconazole or has a documented azole-resistant infection, Brexafemme may still be the best option — cost assistance becomes critical in these cases.

OTC Topical Options

• Miconazole (Monistat): $10–$20 OTC, 1-7 day topical treatment
• Clotrimazole: $7–$15 OTC, topical cream
• Considerations: Appropriate for uncomplicated VVC. Not ideal for recurrent or resistant cases.

RVVC Prevention Alternative: Oteseconazole (Vivjoa)

• Cost: ~$900 per course
• Route: Oral, different dosing schedule than Brexafemme
• Considerations: Also expensive, but may have different insurance coverage. Still an azole, so may not be appropriate for azole-resistant cases where Brexafemme's unique mechanism offers an advantage.

When discussing alternatives, document the clinical rationale for Brexafemme in the patient's chart. This documentation supports prior authorization requests and appeals if insurance initially denies coverage.

Building Cost Conversations into Your Workflow

Many providers understandably find cost discussions uncomfortable or time-consuming. Here are practical ways to integrate them into your existing workflow:

At the Point of Prescribing

• Lead with transparency: "Brexafemme can be expensive — let me tell you about some programs that can help with the cost."
• Check formulary status before writing the prescription if your EHR has real-time benefit check (RTBC) capabilities
• Offer the copay card information proactively — don't wait for patients to ask about cost

At the Staff Level

• Train front desk and MA staff to provide copay card information when patients are prescribed specialty medications
• Create a "savings resources" handout for Brexafemme that includes the manufacturer program, discount card websites, and PAP contact information
• Establish a workflow for handling prior authorization requests promptly — delays in PA can lead to patients abandoning prescriptions

At Follow-Up

• Ask patients if they were able to fill their prescription. If not, explore why — cost is often the unspoken reason
• Document cost barriers in the chart to support future insurance appeals
• For RVVC patients on monthly dosing, check in periodically about ongoing affordability

Leverage Your Pharmacy Partnerships

• Develop relationships with pharmacists who can help navigate insurance issues
• Consider specialty pharmacy referrals for patients struggling to find Brexafemme in stock — specialty pharmacies often have dedicated teams for insurance navigation
• Use Medfinder for providers to help patients locate pharmacies with Brexafemme availability

Prior Authorization Tips

If a patient's insurer requires prior authorization for Brexafemme, these strategies can improve approval rates:

• Document failure of or contraindication to first-line therapy (Fluconazole)
• Include diagnosis codes for recurrent VVC when applicable
• Note any culture results showing azole-resistant Candida species
• Reference Brexafemme's unique mechanism of action as clinical justification
• Submit appeals promptly if initially denied — many denials are overturned on appeal

Final Thoughts

The decision to prescribe Brexafemme is a clinical one, but the ability to fill the prescription is often a financial one. By proactively addressing cost, connecting patients with savings programs, and building efficient workflows for prior authorization and assistance applications, you can significantly improve the chances that your patients actually receive the treatment you've prescribed.

For more provider resources, visit Medfinder for Providers. For clinical information, explore our guides on Brexafemme shortage updates for providers and helping patients find Brexafemme in stock.