Coverage

Use the Coverage Tool to get real-time information about formulary coverage for AREXVY in your area.

Coverage and Cost-Sharing for AREXVY

  • For Medicare Part D per the Inflation Reduction Act:
    AREXVY is covered and patients will pay $0 out of pocket for AREXVY.1*†
  • For Commercial Plans:
    AREXVY is covered for nearly all patients 60 years and older at no cost when administered in-network.2,3*

    AREXVY is expected to be covered for patients 50-59 years of age who are at increased risk for LRTD caused by RSV.3*‡

Available at all major retail pharmacies in the United States.§

For additional questions about billing, coding, and reimbursement for GSK vaccines, visit the GSK Vaccines Reimbursement Support Center or contact the Support Center:

Phone icon

Phone: 1-855-636-8291    
Fax: 1-877-683-1329


Monday – Friday 8:00 am – 8:00 pm ET

*Coverage, coding, cost to patient, reimbursement amount for product, and administration fee will vary by payer, plan (including whether your patient is covered by Medicare or commercial insurance), patient, professional setting, or services rendered, and are subject to change without notice. Cost to patients may vary. Coverage and reimbursement decisions are made by individual insurance plans following receipt of claims from providers. Providers must follow documentation and billing requirements of payer.

†For Medicare Part D patients (pharmacy benefit), AREXVY may be administered at an in- or out-of-network retail pharmacy. Prescribers enrolled in a web-assisted portal for Medicare Part D vaccines administered in-office may electronically submit out-of-network claims to Medicare Part D plans for AREXVY.4

‡Coverage will depend on how the employer plan sponsor interprets and applies the ACIP recommendation within their plan offering. Source: Section 2713(a)(2) of the Public Health Service Act, as added by section 1001 of the ACA, implemented at 26 CFR 54.9815-2713(a)(1)(ii), 29 CFR 2590.715-2713(a)(1)(ii), and 45 CFR 147.130(a)(1)(ii). This requirement does not apply to grandfathered health plan coverage under section 1251 of the ACA, implemented at 26 CFR 54.9815-1251, 29 CFR 2590.715-1272, and 45 CFR 147.140.

§Stocking at individual stores may vary.