Does Blue Cross Blue Shield Cover Cosentyx?
The verdict
Covered on most plans
BCBS plans cover Cosentyx on the specialty tier with prior authorization and TNF-first step therapy, but BCBS is 30-plus independent licensees and exact tier, step-therapy sequence, and specialty pharmacy vary by state plan. Some licensees — including Blue Shield of California — list Cosentyx as a preferred IL-17 agent once TNF-inhibitor step therapy has been completed. Coverage is broad; administrative friction and coinsurance are the real barriers.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Blue Cross Blue Shield using your member ID.
Key facts
Cosentyx (secukinumab) is approved by the FDA for plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis in adults.
FDA drug labeling — Cosentyx (secukinumab)
The 2026 Medicare Part D out-of-pocket cap is $2,100; once reached, the plan pays 100% of covered drug costs for the rest of the year — a key protection for specialty-biologic patients.
CMS.gov — Medicare Part D benefit parameters 2026
Blue Shield of California lists Cosentyx as a preferred IL-17 agent with PA and TNF-first step therapy, illustrating that BCBS licensee formulary positioning for Cosentyx varies across the 30-plus-member federation.
Blue Shield of California formulary / drug policy
Medicare vs. commercial coverage
Whether Blue Cross Blue Shield covers Cosentyx depends heavily on which kind of plan you hold. They follow completely different rules — here's each one, side by side.
Medicare
Part D & Advantage plans
Medicare Part D (BCBS Medicare Advantage-PD plans): Cosentyx is on the specialty tier with PA and step therapy. Members pay approximately 31% coinsurance after the deductible; the $2,100 (2026) Part D out-of-pocket cap limits total annual drug spend. The manufacturer Cosentyx Connect savings card is not available to Medicare or Medicaid beneficiaries under federal anti-kickback rules. Verify the formulary tier on your specific BCBS Medicare Advantage or Part D plan.
Commercial / Employer
Group & marketplace plans
Commercial/Employer plans: Cosentyx is covered on the specialty tier (Tier 4 or 5) with PA and indication-specific step therapy through preferred TNF inhibitors (adalimumab biosimilar, Enbrel) first; some BCBS licensees also require trying Taltz (ixekizumab) as the preferred IL-17 before Cosentyx. Blue Shield of California lists Cosentyx as a preferred IL-17 agent with PA plus TNF-first step therapy. The Cosentyx Connect copay program can reduce out-of-pocket cost to as low as $0 for eligible commercially insured patients. ACA/Individual marketplace BCBS plans also cover Cosentyx on the specialty tier with PA where offered; licensee-specific. Medicaid: BCBS-managed Medicaid plans cover Cosentyx per state PDL with PA and step therapy; nominal cost-share. All tiers and copays vary by licensee — verify on your state BCBS formulary.
The 5 boxes you must tick to get approved
Commercial plans that will consider Cosentyx require prior authorization. Check off what applies to you to see how close you are — this is a guide, not a guarantee of approval.
Meet all 5 and you have a documented case for approval. Missing any one is the most common reason requests are denied.
Your cost, three ways
What Cosentyx actually costs you swings enormously depending on how it's covered. Here's the realistic range.
Paying cash
Approximately $7,936 per month for the 150 mg or 300 mg self-injection package (July 2025 estimate); approximately $11,006 for two 150 mg/mL Sensoready pens at some pharmacies (estimate). Treat all cash figures as estimates — verify current pricing before use.
List price with no coverage — before any manufacturer savings card.
With coverage
Commercial specialty tier: typically 25-50% coinsurance (composite range; varies by BCBS licensee and plan design). Medicare Part D: approximately 31% coinsurance after the deductible, capped at $2,100 for 2026. Medicaid: nominal cost-share per state PDL.
Typical monthly copay once prior authorization is approved.
Bridge program
Cosentyx Connect copay program: as little as $0 per month for eligible commercially insured patients. Not available to Medicare or Medicaid beneficiaries. Visit novartis.com/us-en/patients/support-programs/cosentyx-connect or call 1-844-COSENTYX for enrollment.
Reduced copay through the assistance program, where eligible.
All figures are estimates; coinsurance percentage varies by BCBS licensee and individual plan design. Confirm your exact cost-share on your plan's Summary of Benefits or by calling the member services number on your insurance card.
Check YOUR exact coverage in 3 steps
General answers only get you so far. Here's how to confirm your own plan's decision in a few minutes.
- 1
Look up Cosentyx on your BCBS plan's online drug formulary
Go to your specific state BCBS plan's website (not a national BCBS page) and use the drug-lookup or formulary search tool. Search for both 'Cosentyx' and 'secukinumab.' Note the tier, any PA or step-therapy requirement, and the designated specialty pharmacy.
- 2
Request a Prior Authorization through your prescribing specialist
Your dermatologist or rheumatologist initiates the PA. Gather clinical notes documenting your diagnosis, the indications tried (topical therapies, prior TNF inhibitors), and the reason Cosentyx is medically necessary. Your doctor's office typically submits to the PBM on your behalf.
- 3
Contact Cosentyx Connect if you are commercially insured
If your BCBS plan approves coverage but your coinsurance is still high, enroll in the Cosentyx Connect copay program through Novartis. For Medicare patients, ask your care team about Medicare Extra Help (Low Income Subsidy) if you meet income qualifications — the manufacturer program cannot assist Medicare or Medicaid enrollees.
Options if Blue Cross Blue Shield won't cover Cosentyx
A denial isn't the end of the road. These are the paths people commonly explore next — discuss any of them with your prescriber.
Adalimumab biosimilar (Humira class)
TNF inhibitors — including Amjevita, Hyrimoz, and other adalimumab biosimilars — are typically the first step-therapy option BCBS plans require before Cosentyx for psoriatic arthritis and ankylosing spondylitis. These are preferred on most formularies and have established safety records.
Enbrel (etanercept)
Another TNF inhibitor that many BCBS plans list as a preferred biologic before Cosentyx. Note: no etanercept biosimilar is currently marketed in the US (biosimilars blocked until 2029); branded Enbrel remains the only option.
Taltz (ixekizumab)
A fellow IL-17A inhibitor that some BCBS plans prefer over Cosentyx (or vice versa). Blue Shield of California lists Cosentyx as the preferred IL-17 with Taltz as a non-preferred alternative, but this varies by licensee — check your specific BCBS formulary.
Skyrizi (risankizumab)
An IL-23 inhibitor approved for plaque psoriasis and psoriatic arthritis. Some BCBS plans list Skyrizi on the specialty tier alongside or instead of Cosentyx. Formulary placement varies by licensee.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Yes, BCBS plans cover Cosentyx on the specialty tier (Tier 4 or 5) with prior authorization and step therapy, but BCBS is 30-plus independent licensees and the exact tier, step-therapy requirements, and specialty pharmacy differ by state plan. Coverage is broad across commercial, Medicare Advantage, and Medicaid lines — the barriers are administrative (PA, TNF-first step therapy) and cost-related (25-50% coinsurance on commercial plans). Verify on your specific state BCBS formulary.
Most BCBS licensees require a documented trial of at least one preferred TNF inhibitor — typically an adalimumab biosimilar (Humira class) or Enbrel — before approving Cosentyx. Some plans additionally require a trial of Taltz (ixekizumab), the other major IL-17 agent, as a preferred IL-17 before Cosentyx. Blue Shield of California lists Cosentyx as the preferred IL-17 agent once TNF-inhibitor step therapy is completed. Your state BCBS plan's specific sequence is in its medical or drug policy.
With BCBS commercial insurance, you typically pay 25-50% coinsurance (a composite range; varies by licensee and plan design). With a BCBS Medicare Advantage or Part D plan, coinsurance is approximately 31% after the deductible, capped at $2,100 for 2026 — after that you pay nothing for the rest of the year. Commercially insured patients can reduce their cost sharply using the Cosentyx Connect copay card (as low as $0). The copay card is not available to Medicare or Medicaid enrollees.
The specialty pharmacy depends on which PBM your BCBS licensee uses: Prime Therapeutics (common for many BCBS plans), CVS Caremark, Express Scripts, or OptumRx. Your PA approval letter and plan documents will name the contracted specialty pharmacy. You must use the plan-designated specialty pharmacy to receive the in-network benefit; using an out-of-network pharmacy may result in higher cost-share or denial.
Yes, commercially insured BCBS members are eligible for the Cosentyx Connect copay program (as little as $0 per month for eligible patients). However, the card is not available to members on Medicare, Medicaid, or any other federally funded program. Enrolling is free; visit the Novartis Cosentyx Connect website or call 1-844-COSENTYX. If the standard copay program cannot help (e.g., Medicare), ask your care team about Medicare Extra Help or state pharmaceutical assistance programs.
If your initial PA is denied, your prescriber can file an appeal documenting clinical necessity and any prior treatment failures. You can also request an exception if you have a contraindication to the required step-therapy agents. Under ACA rules, BCBS plans must provide a written denial with the specific reason, and you have the right to an internal appeal and then an independent external review. Your Novartis patient-support representative can assist with appeal documentation.
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Read moreThis content is for informational purposes only and does not constitute medical, financial, or insurance advice. Coverage rules, prior-authorization criteria, and copay amounts change frequently and vary by plan, formulary tier, and effective date — always verify current benefits directly with Blue Cross Blue Shield before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.