Does SelectHealth Cover Dupixent?
The verdict
Covered on most plans
SelectHealth (Intermountain Healthcare's regional health plan in Utah, Idaho, and Nevada) covers Dupixent on the specialty tier with prior authorization and step therapy per its formulary. SelectHealth is a regional plan and its tier, step-therapy sequence, and specialty-pharmacy details are plan-specific and not broadly published externally. Coverage follows the near-universal specialty-biologic pattern for this drug class; verify your specific plan's details on the SelectHealth formulary.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with SelectHealth using your member ID.
Key facts
SelectHealth is Intermountain Healthcare's health plan, serving Utah, Idaho, and Nevada — it operates as a regional insurer with its own formulary and is not part of a national insurer network.
SelectHealth — plan information
Dupixent (dupilumab) is FDA-approved for six indications: atopic dermatitis (age 6 months+), moderate-to-severe asthma (age 6+), chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, prurigo nodularis, and COPD with eosinophilic phenotype.
FDA drug labeling — Dupixent (dupilumab), Sanofi/Regeneron
The 2026 Medicare Part D out-of-pocket cap is $2,100; SelectHealth Medicare Part D members who reach this threshold pay $0 for covered drugs for the rest of the calendar year.
CMS.gov — Medicare Part D benefit parameters 2026
Medicare vs. commercial coverage
Whether SelectHealth covers Dupixent 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
SelectHealth Medicare Part D plans: Dupixent is on the specialty tier with PA and step therapy. Members pay approximately 25-33% coinsurance after the deductible, capped at $2,100 for 2026 — the plan pays 100% of covered drug costs above that cap for the rest of the year. Per Sanofi/Regeneron, about 79% of Medicare Part D Dupixent recipients pay $0-$100 per month under post-IRA catastrophic protections. The Dupixent MyWay copay card is not available to Medicare beneficiaries. When Dupixent is administered in a clinical setting, it may shift to Medicare Part B (medical benefit) rather than Part D. Verify the tier and PA criteria on your SelectHealth Medicare plan documents.
Commercial / Employer
Group & marketplace plans
Commercial/Employer (SelectHealth HMO/PPO) plans: Dupixent is on the specialty tier with PA and indication-specific step therapy per SelectHealth's formulary. Cost-share follows the member's specific SelectHealth plan design (copay or coinsurance); typical specialty-tier coinsurance is 25-33%. The Dupixent MyWay copay card (Sanofi/Regeneron) can reduce commercial member out-of-pocket cost to as little as $0 for eligible patients. ACA/Individual marketplace SelectHealth plans (Utah, Idaho, Nevada marketplaces) also cover Dupixent on the specialty tier with PA where offered. Medicaid: SelectHealth Community Care (Utah Medicaid managed-care) covers Dupixent per state PDL with PA and step therapy; nominal cost-share. Medical vs. pharmacy benefit: primarily pharmacy-benefit self-injected; can flip to medical benefit when clinic-administered.
The 5 boxes you must tick to get approved
Commercial plans that will consider Dupixent 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 Dupixent actually costs you swings enormously depending on how it's covered. Here's the realistic range.
Paying cash
Approximately $3,993 per carton of 2 pre-filled pens (list price, Jan 2025 estimate); average retail approximately $5,350-$5,377 per month (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 25-33% coinsurance (composite range; exact percentage varies by SelectHealth plan design — verify on plan documents). Medicare Part D: approximately 25-33% coinsurance after deductible, capped at $2,100 for 2026. SelectHealth Community Care (Utah Medicaid): nominal cost-share.
Typical monthly copay once prior authorization is approved.
Bridge program
Dupixent MyWay copay program (Sanofi/Regeneron): as little as $0 per month for eligible commercially insured patients. Not available to Medicare, Medicaid, or other government-plan enrollees. Enroll at dupixent.com/myway or call 1-844-DUPIXENT.
Reduced copay through the assistance program, where eligible.
All copay figures are estimates. SelectHealth plan-specific cost-share varies by plan design; confirm your exact cost-share on your SelectHealth Summary of Benefits or by calling SelectHealth member services.
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
Search Dupixent on the SelectHealth formulary or drug-lookup tool
Go to selecthealth.org and use the drug-lookup or formulary tool for your specific plan type (commercial, Medicare, or marketplace). Search for both 'Dupixent' and 'dupilumab.' Because SelectHealth is a regional plan, tier and step-therapy details may not match broader national insurer descriptions — rely on SelectHealth's own formulary for your specific plan.
- 2
Have your specialist initiate a Prior Authorization
Your allergist, dermatologist, pulmonologist, or gastroenterologist initiates the PA. Clinical documentation must include diagnosis, prior treatment history demonstrating step-therapy completion, current disease severity, and supporting labs. Your physician's office submits the PA to SelectHealth's PBM or utilization management team.
- 3
Enroll in Dupixent MyWay if you are commercially insured
After PA approval, enroll in the Dupixent MyWay copay program at dupixent.com/myway to reduce specialty-tier coinsurance to as low as $0 for eligible commercial members. For Medicare beneficiaries, the $2,100 (2026) Part D cap limits annual exposure. If you need further assistance on Medicare, ask your care team about Medicare Extra Help (Low Income Subsidy).
Options if SelectHealth won't cover Dupixent
A denial isn't the end of the road. These are the paths people commonly explore next — discuss any of them with your prescriber.
Topical corticosteroids and calcineurin inhibitors
For atopic dermatitis: required step-therapy agents before Dupixent per SelectHealth's formulary guidelines. Documented failure of high-potency topical steroids and calcineurin inhibitors is a standard PA prerequisite for this drug class.
Xolair (omalizumab), Nucala (mepolizumab), Tezspire (tezepelumab)
For asthma: preferred biologics that SelectHealth may require as step therapy before Dupixent depending on phenotype. Confirm the required sequence on SelectHealth's drug-management policy or through your prescriber.
Prolia (denosumab) — for context on benefit-rail differences
Prolia (at any insurer) is a medical-benefit buy-and-bill injection given in a clinic every six months — the opposite of Dupixent's pharmacy-benefit self-injection model. SelectHealth has no other specialty biologic page in this cluster, so this contrast illustrates that 'specialty drug' does not always mean 'pharmacy-benefit self-injection.'
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Yes, SelectHealth (Intermountain's health plan in Utah, Idaho, and Nevada) covers Dupixent on the specialty tier with prior authorization and indication-specific step therapy per its formulary. SelectHealth is a regional plan, and the specific tier, step-therapy drugs required, and specialty pharmacy are set by SelectHealth's own formulary — not broadly published externally. Verify on the SelectHealth formulary or by calling member services.
SelectHealth is the health insurance arm of Intermountain Healthcare, one of the largest not-for-profit health systems in the western United States. SelectHealth operates primarily in Utah, Idaho, and Nevada and offers commercial HMO and PPO plans, Medicare Advantage and Part D plans, and marketplace ACA plans, as well as SelectHealth Community Care (Utah Medicaid managed-care). It is a regional plan without a national presence.
With SelectHealth commercial insurance, expect specialty-tier coinsurance of approximately 25-33% — confirm the exact percentage on your plan documents. The Dupixent MyWay copay card can reduce eligible commercial members' cost to as little as $0. With SelectHealth Medicare Part D, coinsurance is approximately 25-33% after the deductible, capped at $2,100 for 2026. About 79% of Medicare Part D Dupixent recipients pay $0-$100 per month per Sanofi/Regeneron.
Yes, SelectHealth covers Dupixent for all FDA-approved indications, including moderate-to-severe atopic dermatitis and asthma, subject to prior authorization and indication-specific step therapy. For atopic dermatitis, step therapy typically requires documented failure of topical agents; for asthma, documented failure of standard controller therapy and possibly preferred biologics. Verify SelectHealth's specific PA criteria for your indication on the SelectHealth formulary or drug-management policy pages.
Dupixent is primarily dispensed as a self-injected pharmacy-benefit drug through SelectHealth's specialty-pharmacy network. When administered by a clinician in an office or clinical setting, it can shift to the medical benefit — billed under Medicare Part B for Medicare members or under the medical cost-share for commercial plans. Most patients receive Dupixent as a home self-injection under the pharmacy benefit.
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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 SelectHealth before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.