Cost Is an Adherence Barrier — Here's How to Address It

You've determined that Kesimpta (Ofatumumab) is the right treatment for your patient's relapsing MS. The clinical evidence supports it, the patient is on board, and then the conversation turns to cost. At $6,800 to $7,500 per monthly dose — roughly $82,000 to $90,000 per year — the sticker price can stop patients in their tracks, even when insurance covers most of it.

Cost-related non-adherence is well-documented in MS. Patients who face high out-of-pocket costs are more likely to delay fills, skip doses, or abandon treatment altogether. As a prescriber, understanding the available financial support programs — and knowing how to connect patients to them efficiently — is one of the most impactful things you can do for treatment adherence.

This guide covers every major savings pathway for Kesimpta in 2026.

What Patients Are Actually Paying

Before diving into solutions, it helps to understand the landscape:

• Commercially insured patients: Co-pays for specialty biologics typically range from $50 to $500+ per month, depending on the plan's formulary tier and co-insurance structure. Many plans place Kesimpta on a specialty tier with 20-30% co-insurance.
• Medicare Part D patients: Often face the highest burden. Specialty tier co-insurance can mean thousands of dollars per year, even after the coverage gap reforms. The Kesimpta Access Card is not available to Medicare beneficiaries.
• Uninsured patients: Face the full cash price — effectively unaffordable without assistance.
• Medicaid patients: Typically have minimal cost-sharing, but prior authorization requirements can delay access.

According to Novartis data, 97% of Kesimpta prescriptions filled have $0 out-of-pocket cost when patients use available support programs. The challenge is ensuring your patients actually enroll.

Manufacturer Savings Programs

Kesimpta Access Card (Co-Pay Assistance)

This is the primary savings tool for commercially insured patients:

• Eligibility: Patients with commercial insurance (not Medicare, Medicaid, or other federal/state programs)
• Benefit: Up to $18,000 per year in co-pay assistance. Most eligible patients pay $0 out of pocket.
• Bridge program: Patients who are initially denied insurance coverage may receive free Kesimpta for up to 12 months while their coverage appeal is in process.
• Enrollment: Online at start.kesimpta.com or through the Novartis patient support team.
• Clinic integration: Your office can enroll patients directly. Many MS specialty practices have a dedicated patient access coordinator who handles this as part of the prescribing workflow.

Novartis Patient Assistance Foundation (NPAF)

For uninsured or underinsured patients who meet income criteria:

• Eligibility: Uninsured or underinsured patients (including some Medicare patients who meet financial criteria)
• Benefit: Free Kesimpta for qualifying patients
• Application: Available at patient.novartis.com or by calling 1-800-277-2254
• Documentation: Requires proof of income and insurance status. Your office may need to provide a prescription and clinical documentation.

Tip for providers: Submit PAP applications proactively when you identify patients at risk for cost barriers. Don't wait for the patient to report problems filling their prescription.

Coupon and Discount Cards

Traditional pharmacy discount cards (GoodRx, SingleCare, RxSaver, etc.) are generally not useful for Kesimpta. Here's why:

• Kesimpta is distributed through specialty pharmacies, not retail pharmacies where most coupon cards apply.
• The cash price is so high ($6,800-$7,500/month) that discount card savings are negligible compared to insurance + manufacturer co-pay assistance.
• Most patients who would benefit from a coupon card are better served by the NPAF (patient assistance) program.

That said, if a patient is in a coverage gap or transitioning between insurance plans, it's worth checking whether their specialty pharmacy accepts any discount programs as a temporary bridge.

Generic Alternatives and Therapeutic Substitution

There is no generic or biosimilar version of Kesimpta available as of 2026. However, therapeutic alternatives exist within and outside the anti-CD20 class that may offer cost advantages for certain patients:

Within the Anti-CD20 Class

• Rituximab — Used off-label for MS. Significantly cheaper, especially as biosimilars are available (Truxima, Ruxience, Riabni). Administered as IV infusion every 6 months. Many MS centers use rituximab when cost is the primary barrier. Not FDA-approved for MS, which can complicate insurance coverage.

Other High-Efficacy Options

• Ocrevus (Ocrelizumab) — FDA-approved anti-CD20 for RMS and PPMS. IV infusion every 6 months. Similar cost profile to Kesimpta, but Genentech offers its own co-pay program.
• Tysabri (Natalizumab) — Monthly IV infusion. Different mechanism. Biogen offers patient support programs.

Lower-Cost Oral Alternatives

• Aubagio (Teriflunomide) — Daily oral pill. Generic teriflunomide is available and substantially cheaper. Lower efficacy than Kesimpta for active disease.
• Mavenclad (Cladribine) — Oral tablets taken in short courses over 2 years. Can be cost-effective due to limited dosing schedule.

For a full comparison, see our patient-facing guide to Kesimpta alternatives.

The decision to substitute should always be clinical first, but when two options offer similar efficacy, cost can reasonably tip the scale.

Building Cost Conversations Into Your Workflow

The most effective practices integrate financial screening into the prescribing process rather than treating it as an afterthought. Here's what works:

1. Screen Early

Ask about insurance status, co-pay concerns, and financial constraints before writing the prescription. A 30-second conversation can prevent a prescription from going unfilled for weeks.

2. Designate a Point Person

Whether it's a nurse, medical assistant, or dedicated patient access coordinator, having someone in your office who owns the financial navigation process makes a measurable difference. This person should know:

• How to enroll patients in the Kesimpta Access Card
• How to submit NPAF applications
• How to handle prior authorization denials and appeals
• Which specialty pharmacies your common insurance plans use

3. Document and Follow Up

Track which patients have been enrolled in assistance programs and follow up if prescriptions aren't being filled on schedule. Specialty pharmacies can often flag adherence issues proactively.

4. Use Manufacturer Rep Resources

Novartis field reimbursement managers (FRMs) can provide in-office training, help with complex cases, and keep your team updated on program changes. Don't hesitate to use them.

5. Know the Appeals Process

When insurance denies prior authorization, a peer-to-peer review or a well-documented appeal letter often reverses the decision. Template appeal letters are available through Novartis support and through professional organizations like the American Academy of Neurology.

Additional Resources for Providers

• Medfinder for Providers: medfinder.com/providers — Tools to help your patients find specialty medications in stock.
• National MS Society: Offers financial assistance resources and can help connect patients with local support.
• Patient Access Network (PAN) Foundation: May offer co-pay assistance for MS treatments for patients on Medicare or with high cost-sharing.
• HealthWell Foundation: Another source of co-pay grants for patients with chronic conditions including MS.

Final Thoughts

The clinical value of Kesimpta is clear. The challenge — as with many specialty biologics — is ensuring that cost doesn't become the reason a patient doesn't start or stay on the treatment you've prescribed. By building financial navigation into your workflow and knowing which programs are available, you can significantly improve adherence and outcomes.

For help with medication access and availability, visit Medfinder for Providers. For more clinical and patient-facing resources on Kesimpta, explore our guides on shortage updates for providers and helping patients find Kesimpta in stock.