Cost Is the Biggest Barrier to Kerendia Adherence

You've determined that Kerendia (Finerenone) is the right choice for your patient — they have CKD with type 2 diabetes or qualifying heart failure, their potassium is in range, and there are no contraindicated medications on their list. But when they get to the pharmacy, the price stops them cold.

Kerendia has a cash price of $670 to $950 per month. Even with insurance, copays can be prohibitive depending on tier placement and prior authorization requirements. As a prescriber, you're in a unique position to help patients navigate the financial landscape before they hit the pharmacy counter — and that proactive step can be the difference between adherence and abandonment.

This guide covers every savings option available for Kerendia in 2026, along with practical tips for integrating cost conversations into your clinical workflow.

What Your Patients Are Paying

Here's the current cost landscape for Kerendia:

• Cash price (no insurance): $670–$950 for 30 tablets (one-month supply)
• Commercial insurance: Typically Tier 3 (preferred brand) or Tier 4 (non-preferred brand). Copays range from $30 to $200+ per month depending on the plan. Prior authorization is commonly required.
• Medicare Part D: Covered, but copays vary widely by plan. Patients in the coverage gap face significantly higher costs. Medicare Extra Help can reduce cost to $10 or less per month.
• Uninsured/underinsured: Full cash price, which is unsustainable for most patients without assistance.

The bottom line: without intervention, a significant portion of your patients will face cost barriers that threaten adherence. And for a medication designed to prevent progressive kidney failure and cardiovascular events over time, adherence is everything.

Manufacturer Savings Programs

Bayer Kerendia Savings Card

This is the first-line cost reduction tool for commercially insured patients:

• Eligibility: Patients with commercial (private) insurance
• Benefit: May reduce copay to as low as $0 per month, up to a maximum annual benefit
• Not eligible: Medicare, Medicaid, Tricare, or other government insurance beneficiaries
• How to enroll: Patients can enroll through the Kerendia savings card website, or your office can assist with enrollment during the visit

This card should be discussed with every commercially insured patient at the time of prescribing. Many patients don't know it exists until they're already at the pharmacy facing a high copay.

Bayer Patient Assistance Program (PAP)

For patients who are uninsured or underinsured:

• Eligibility: Uninsured or underinsured patients who meet income requirements
• Benefit: Kerendia provided at no cost
• How to apply: Through Bayer's patient support website or by calling their support line. Your office may need to provide supporting documentation (prescription, income verification).

PAPs take time to process — typically 2 to 4 weeks. If your patient needs to start Kerendia before the PAP is approved, see if they qualify for bridge samples or a short-term savings card while the application is pending.

Coupon and Discount Card Programs

For patients paying cash or facing high copays not covered by the manufacturer card, third-party discount programs can help:

• GoodRx: Shows real-time pricing at local pharmacies and offers coupons that may reduce the cash price
• SingleCare: Similar to GoodRx, provides discount pricing at participating pharmacies
• RxSaver: Compares prices and offers discount cards
• Optum Perks: Discount program available to anyone

Important caveat: for a brand-name medication like Kerendia with no generic available, discount cards typically provide modest savings compared to the manufacturer savings card or PAP. They're most useful as a backup when other options don't apply.

Patients can also check multiple pharmacy prices on Medfinder for Providers to compare availability and pricing.

Insurance Navigation Tips

Prior Authorization

Most commercial and Medicare plans require prior authorization for Kerendia. Streamline this process:

• Submit the PA proactively at the time of prescribing — don't wait for the pharmacy rejection
• Include clinical documentation: diagnosis (CKD with T2D or qualifying HF), current eGFR, potassium level, and documentation of ACE inhibitor or ARB use (many plans require step therapy)
• If denied, appeal with clinical rationale citing the FIDELIO-DKD and FIGARO-DKD trial data

Step Therapy

Some insurers require trial of an ACE inhibitor or ARB before approving Kerendia. Kerendia is intended to be used in addition to ACE/ARB therapy (not as a replacement), so most patients will already meet this requirement. Document clearly in the PA submission.

Tier Exceptions

If Kerendia is placed on a high tier (Tier 4 or specialty tier), you can request a tier exception from the insurer by providing clinical justification for why the patient needs Kerendia specifically and cannot use a lower-tier alternative.

Generic Alternatives and Therapeutic Substitution

There is currently no generic version of Kerendia. Bayer's patent is expected to expire around 2029.

However, if cost is an absolute barrier and the patient cannot access any savings program, consider therapeutic alternatives:

• Spironolactone — steroidal MRA, available as a generic for $4–$15/month. More side effects (gynecomastia, sexual dysfunction) and not FDA-approved for CKD with diabetes, but provides MR blockade.
• Eplerenone — steroidal MRA with better selectivity than Spironolactone, available as a generic. Primarily indicated for heart failure and hypertension.
• Dapagliflozin (Farxiga) — SGLT2 inhibitor approved for CKD. Different mechanism but proven kidney and cardiovascular protection. May be available at lower cost depending on insurance.
• Empagliflozin (Jardiance) — SGLT2 inhibitor with CKD and heart failure indications.

These are not direct substitutes — they have different mechanisms, indications, and side effect profiles. But when cost threatens to derail treatment entirely, therapeutic substitution that keeps the patient on some form of kidney/heart protection is better than no treatment. For a clinical comparison, see our alternatives to Kerendia article.

Building Cost Conversations into Your Workflow

Cost conversations shouldn't be an afterthought. Here's how to integrate them into your prescribing workflow:

At the Time of Prescribing

1. Discuss cost upfront: "Kerendia is a brand-name medication that can be expensive. Let me walk you through the savings options."
2. Check insurance coverage before the patient leaves. A quick benefits check can tell you the likely copay and whether PA is needed.
3. Enroll in the savings card during the visit for commercially insured patients. It takes minutes and saves the patient a surprise at the pharmacy.
4. Start the PAP application during the visit for uninsured patients.
5. Submit prior authorization proactively — don't wait for pharmacy rejection.

At Follow-Up

1. Ask about cost: "Were you able to fill the prescription? Did you have any issues with cost?"
2. Check adherence: If the patient is taking less than prescribed, cost is often the reason.
3. Reassess savings programs annually — insurance plans change, copay card benefits reset, and new programs may become available.

Staff Training

• Train front-desk and clinical staff to initiate savings card enrollment and PA submissions
• Keep a quick-reference sheet of Kerendia savings programs in your EHR or break room
• Designate a financial navigator or patient advocate if your practice has one

Additional Resources

• Patient assistance databases: RxAssist (rxassist.org), NeedyMeds (needymeds.org), and RxHope (rxhope.com) maintain searchable databases of manufacturer PAPs
• Medfinder for Providers: medfinder.com/providers — help patients locate pharmacies with Kerendia in stock and compare pricing
• State pharmaceutical assistance programs (SPAPs): Some states offer additional drug assistance for residents — check your state's health department website

Final Thoughts

Kerendia has strong clinical evidence for kidney and cardiovascular protection in CKD with type 2 diabetes and qualifying heart failure. But evidence means nothing if patients can't afford to fill the prescription. By proactively addressing cost at the point of prescribing — enrolling patients in savings cards, initiating PAPs, and building cost into your clinical workflow — you can dramatically improve adherence and outcomes.

The few minutes it takes to have the cost conversation and set up a savings program can save your patient hundreds of dollars a month and keep them on a therapy that protects their kidneys and heart for years to come.