The Cost Challenge: Why Patients Need Your Help

Symproic (Naldemedine) is an effective treatment for opioid-induced constipation (OIC), but its cost presents a significant barrier to patient adherence. With no generic available, the cash price for a 30-day supply ranges from $484 to $746. Even patients with commercial insurance may face substantial copays, and prior authorization requirements can delay treatment initiation.

As a prescriber, you're in a unique position to help patients navigate the financial landscape. This guide covers the savings programs, assistance options, and clinical strategies available to reduce Symproic costs for your patients.

Understanding the Insurance Landscape for Symproic

Commercial Insurance

Most major commercial insurance plans cover Symproic, though coverage is frequently subject to:

• Prior authorization — Documentation of OIC diagnosis and current opioid therapy
• Step therapy — Demonstrated failure of at least one conventional laxative (e.g., polyethylene glycol, bisacodyl, or senna)
• Preferred drug lists — Some PBMs prefer Movantik (Naloxegol) over Symproic, or vice versa; formulary position varies by plan

Tip: Document laxative trials thoroughly in the medical record. A clear note stating the agent used, duration, dose, and reason for failure streamlines the PA process considerably.

Medicare Part D

Symproic is covered by many Medicare Part D plans, though beneficiaries often face Tier 3 or Tier 4 copays. The manufacturer copay card is not eligible for use by Medicare, Medicaid, or other federal healthcare program beneficiaries — a critical distinction when counseling patients.

For Medicare patients, the best options are typically:

• Medicare Extra Help (Low-Income Subsidy) for qualifying patients
• Patient assistance programs from the manufacturer or third parties
• State pharmaceutical assistance programs (SPAPs) where available

Medicaid

Medicaid coverage for Symproic varies by state. Many state Medicaid programs require prior authorization and step therapy. Some states may not cover PAMORAs at all. Check your state's preferred drug list for current status.

Manufacturer Savings Programs

Symproic Savings Card

The Symproic Savings Program is the most impactful tool for commercially insured patients. Key details:

• Eligible commercially insured patients may pay as little as $0 per prescription
• Available at symproic.com
• Patients can enroll online or receive a card from your office
• Not valid for patients covered by Medicare, Medicaid, TRICARE, VA, or any other federal or state healthcare program

Clinical workflow tip: Keep printed or digital copies of the savings card information available in your prescribing workflow. Proactively offering this at the point of prescribing improves first-fill rates significantly.

Patient Assistance Programs (PAPs)

For uninsured patients or those who cannot afford their medication even with insurance, several assistance programs may help:

Manufacturer-Sponsored Assistance

Contact the manufacturer (Shionogi/BioDelivery Sciences/Collegium Pharmaceutical) directly to inquire about patient assistance for Symproic. Eligibility typically requires:

• U.S. residency
• Lack of prescription drug coverage or inability to afford medication
• Income below a specified threshold (varies by program)

Third-Party Resources

• NeedyMeds (needymeds.org) — Comprehensive database of PAPs, copay assistance, and discount programs
• RxAssist (rxassist.org) — Patient assistance program directory maintained by Volunteers in Health Care
• RxHope (rxhope.com) — Connects patients with manufacturer-sponsored assistance programs

Your office staff or social worker can help patients complete the applications. Many PAPs require a prescriber signature on the application form.

Optimizing Prior Authorization Approvals

A denied prior authorization is one of the most common reasons patients abandon a Symproic prescription. Strategies to improve approval rates:

Documentation Best Practices

1. Clearly document OIC diagnosis — Use ICD-10 code K59.09 (other constipation) or the specific OIC codes. Note the temporal relationship between opioid initiation and constipation onset.
2. Detail laxative trials — Specify the agent, dose, duration, and clinical outcome. "Patient tried MiraLAX 17g daily for 4 weeks with fewer than 3 bowel movements per week" is far more effective than "laxatives failed."
3. Include functional impact — Note how OIC affects quality of life, medication adherence, and daily function.
4. Reference clinical guidelines — Cite the AGA guidelines supporting PAMORA use after inadequate response to first-line laxatives.

Appeal Strategies

If the initial PA is denied:

• Request a peer-to-peer review — speaking directly with the plan's medical director often resolves denials
• Submit a letter of medical necessity with detailed documentation
• Consider formulary exceptions if Symproic is not preferred but clinically indicated (e.g., patient failed Movantik or cannot comply with its fasting requirement)

Clinical Alternatives When Cost Is Prohibitive

When a patient truly cannot afford Symproic and assistance programs are unavailable or insufficient, consider these evidence-based alternatives:

• Movantik (Naloxegol) 25 mg — Another PAMORA; may have different formulary positioning with a lower copay. Requires empty-stomach administration.
• Relistor (Methylnaltrexone) — Available as subcutaneous injection (12 mg) or oral tablet (450 mg). May be covered under medical benefit (injection) vs. pharmacy benefit.
• Amitiza (Lubiprostone) 24 mcg — Chloride channel activator approved for OIC. Different mechanism; twice-daily dosing.

For a detailed clinical comparison, see our provider resource on Symproic Shortage: What Providers Need to Know and our guide to Helping Patients Find Symproic in Stock.

Pharmacy Strategies

Specialty vs. Retail Pharmacy

Some insurance plans require Symproic to be filled through a specialty pharmacy, which can sometimes offer better pricing or patient support services. Conversely, some patients get better pricing at retail pharmacies using the manufacturer savings card. Advise patients to compare both options.

Mail-Order Pharmacy

90-day supplies through mail-order pharmacy often provide cost savings over monthly retail fills. Most PBMs offer this option, and it also reduces the risk of lapses in therapy.

Finding Symproic in Stock

Because Symproic is a brand-only specialty medication, pharmacy availability can be inconsistent. Direct patients to MedFinder for Providers to check real-time pharmacy stock near their location.

Building a Cost-Conscious Prescribing Workflow

Integrating cost considerations into your prescribing workflow ensures patients start therapy — and stay on it. Consider these steps:

1. At the point of prescribing — Check formulary status, initiate PA if required, and provide the savings card
2. At the first follow-up — Confirm the patient filled the prescription and ask about out-of-pocket costs
3. At subsequent visits — Reassess financial burden; connect patients with PAPs if costs become unsustainable
4. Train front-office staff — Ensure your team knows how to help patients enroll in savings programs and navigate PA requirements

Resources for Your Practice

• symproic.com — Official prescribing information, savings card, and patient resources
• NeedyMeds.org — PAP database and discount drug cards
• RxAssist.org — Patient assistance program directory
• MedFinder for Providers — Real-time pharmacy stock checking and provider tools

Key Takeaways

• Symproic costs $484–$746/month without insurance, making financial support essential for adherence.
• The manufacturer savings card can reduce costs to $0 for commercially insured patients — keep this in your prescribing workflow.
• Medicare and Medicaid patients are not eligible for the copay card; direct them to PAPs and NeedyMeds.
• Thorough documentation of OIC diagnosis and laxative failures significantly improves PA approval rates.
• When cost is prohibitive, consider formulary-preferred PAMORAs or alternative OIC agents.
• Use MedFinder for Providers to help patients locate pharmacies with Symproic in stock.