By Counterforce Health Team in Voydeya (danicopan) —

Lowering Out-of-Pocket for Voydeya (danicopan) with Cigna in New York: Copay, Tiering & Assistance

Answer Box: Quick Path to Lower Voydeya Costs

Voydeya (danicopan) is a Tier 4 specialty drug on Cigna's formulary requiring prior authorization and costing 25-33% coinsurance or high copays. To reduce costs: (1) Apply for Alexion OneSource copay assistance (up to $15,000/year for commercial insurance), (2) Request tier exception if denied coverage, (3) Explore foundation grants through NORD or The Assistance Fund. Fill through Accredo specialty pharmacy for coverage. Start with your prescriber initiating prior authorization and copay program enrollment simultaneously.

Table of Contents

What Drives Voydeya Costs

Understanding your out-of-pocket expenses for Voydeya (danicopan) starts with knowing how Cigna structures specialty drug benefits. The medication carries a U.S. list price around $50,000-$100,000 annually, making benefit design crucial to affordability.

Cigna's Formulary Placement

Voydeya appears on Cigna's 2025 National Formulary as a Tier 4 specialty drug, the highest cost-sharing tier. This placement means:

  • Prior authorization required before any coverage
  • Quantity limits (typically 180 tablets per 30 days)
  • Specialty pharmacy dispensing through Accredo mandatory
  • Higher coinsurance (usually 25-33%) or substantial copays

Cost-Sharing Structure

Your specific out-of-pocket amount depends on your Cigna plan type:

Plan Type Typical Tier 4 Cost-Sharing Annual Maximum
Commercial PPO 25-30% coinsurance $3,000-$8,000
Commercial HMO $200-$500 copay $2,500-$6,000
Medicare Advantage 33% coinsurance Varies by plan
Note: These are estimates. Check your Summary of Benefits and Coverage (SBC) for exact amounts.

Investigating Your Cigna Benefits

Before starting treatment, gather specific information about your coverage to identify cost-reduction opportunities.

Key Questions for Cigna Customer Service

Call the number on your insurance card and ask:

  1. "What's my specialty drug coinsurance or copay for Tier 4 medications?"
  2. "What's my annual out-of-pocket maximum for prescription drugs?"
  3. "Does my plan have a specialty drug cap or maximum monthly cost-sharing?"
  4. "Are there any formulary exceptions or tier reduction processes available?"

Information to Document

During your call, record:

  • Representative name and reference number
  • Exact cost-sharing amounts quoted
  • Prior authorization requirements
  • Appeals process timeline
  • Any available cost-reduction programs
Tip: Request written confirmation of cost-sharing amounts via your myCigna portal to avoid surprises.

Manufacturer and Foundation Assistance

Multiple assistance programs can significantly reduce your Voydeya expenses, potentially covering thousands in annual costs.

Alexion OneSource Copay Program

The primary manufacturer assistance covers up to $15,000 per year for eligible patients with commercial insurance.

Eligibility Requirements:

  • Commercial (private) insurance coverage
  • Valid Voydeya prescription for FDA-approved PNH indication
  • Not enrolled in government insurance (Medicare, Medicaid, VA)

Application Process:

  1. Contact Alexion OneSource at 1-888-765-4747
  2. Provide insurance verification documents
  3. Complete enrollment forms with your prescriber
  4. Receive copay card for pharmacy use

Foundation Grant Programs

Several organizations provide additional financial support for PNH patients:

NORD (National Organization for Rare Disorders)

  • PNH-specific assistance program
  • Covers copays, premiums, and treatment-related costs
  • Income-based eligibility requirements
  • Apply online with diagnosis verification

The Assistance Fund

AAMDSIF Travel Assistance

Requesting Formulary Tier Exceptions

When Voydeya's Tier 4 placement creates financial hardship, you can request placement on a lower tier with reduced cost-sharing.

Exception Criteria

Cigna may approve tier reductions when:

  • Lower-tier alternatives are contraindicated
  • You've failed required step therapy medications
  • Clinical evidence supports Voydeya as most appropriate therapy
  • Financial hardship documentation provided

Required Documentation

Submit through your prescriber:

  1. Cigna Formulary Exception Request form
  2. Medical necessity letter detailing:
    • PNH diagnosis with flow cytometry results
    • Current C5 inhibitor therapy details
    • Evidence of extravascular hemolysis despite C5 treatment
    • Prior complement inhibitor trials and outcomes
  3. Supporting clinical evidence:
    • Recent lab results (hemoglobin, reticulocyte count, LDH)
    • Transfusion records if applicable
    • Specialist consultation notes

Submission Process

Your hematologist should:

  1. Complete exception request via Cigna provider portal
  2. Include all supporting documentation
  3. Request expedited review if clinically urgent
  4. Follow up within 72 hours if no response
From our advocates: We've seen tier exceptions succeed when prescribers emphasize that Voydeya addresses a specific unmet need (extravascular hemolysis) that lower-tier alternatives cannot treat, supported by recent lab evidence showing ongoing anemia despite optimized C5 inhibition.

Specialty Pharmacy Coordination

Proper coordination with Accredo, Cigna's designated specialty pharmacy, can prevent delays and additional costs.

Initial Setup

  1. Prescription Transfer: Have your prescriber send Voydeya prescription directly to Accredo
  2. Insurance Verification: Accredo will verify coverage and process prior authorization
  3. Copay Program Setup: Provide Alexion copay card information during intake call
  4. Delivery Coordination: Schedule shipments to align with your treatment schedule

Ongoing Management

Monthly Refill Process:

  • Accredo typically calls 7-10 days before your supply runs out
  • Confirm shipping address and delivery preferences
  • Apply copay assistance at each fill
  • Monitor for any formulary or coverage changes

Cost Monitoring:

  • Review each Explanation of Benefits (EOB) for accuracy
  • Track progress toward annual out-of-pocket maximum
  • Document any billing discrepancies immediately

Contact Information

  • Accredo: 877-826-7657
  • Hours: Monday-Friday 7 AM - 11 PM ET, Saturday 8 AM - 5 PM ET
  • Online: Accredo patient portal

Cost-Based Appeals Strategy

If high costs create access barriers despite assistance programs, consider appeals focused on financial hardship and medical necessity.

When to Appeal on Cost Grounds

  • Tier 4 coinsurance exceeds 20% of monthly income
  • Annual out-of-pocket costs would exceed $5,000
  • Multiple assistance programs have been exhausted
  • Clinical urgency requires immediate access

Appeal Documentation

Financial Hardship Evidence:

  • Recent tax returns or pay stubs
  • Medical expense records for PNH treatment
  • Documentation of assistance program applications
  • Statement of financial impact on family

Clinical Necessity Support:

  • Specialist letter emphasizing treatment urgency
  • Evidence of disease progression without Voydeya
  • Documentation of failed alternatives
  • Quality of life impact statements

New York External Appeal Rights

If Cigna denies your cost-based appeal, New York residents have additional protections:

  1. Internal Appeal First: Complete Cigna's internal process (180-day deadline)
  2. External Review: File with NYS Department of Financial Services within 4 months
  3. Independent Review: DFS assigns external medical experts
  4. Binding Decision: Cigna must comply with external reviewer determination

Free Assistance: Community Health Advocates at 888-614-5400 provides free appeal support for New York residents.

Annual Renewal Planning

Specialty drug costs can change significantly at plan renewal, requiring proactive planning to maintain affordable access.

October-November Preparation

Review Plan Changes:

  • Check 2025 formulary for Voydeya placement
  • Compare Tier 4 cost-sharing across available plans
  • Evaluate specialty pharmacy network changes
  • Assess prior authorization requirement updates

Document Current Treatment:

  • Gather 12 months of treatment records
  • Compile effectiveness evidence (lab improvements, symptom reduction)
  • Update medical necessity documentation
  • Renew copay assistance program enrollment

December Decisions

Plan Selection Factors:

  • Specialty drug annual out-of-pocket maximums
  • Formulary tier placement for Voydeya
  • Accredo network participation
  • Provider network coverage for your hematologist

Budget Planning:

  • Calculate first-quarter out-of-pocket exposure
  • Arrange flexible spending account contributions
  • Plan copay assistance program timing
  • Consider foundation grant application timing

Conversation Scripts

Calling Cigna About Voydeya Coverage

Opening: "I need information about coverage for Voydeya, spelled V-O-Y-D-E-Y-A, for paroxysmal nocturnal hemoglobinuria. My member ID is [number]."

Key Questions:

  • "What tier is Voydeya on my specific plan?"
  • "What's my exact copay or coinsurance amount?"
  • "Is prior authorization required, and how long does approval take?"
  • "Must I use Accredo specialty pharmacy?"
  • "What's my annual out-of-pocket maximum for specialty drugs?"

Requesting Peer-to-Peer Review

For clinic staff: "I need to request a peer-to-peer review for a Voydeya prior authorization denial. The patient has PNH with documented extravascular hemolysis despite C5 inhibitor therapy. Can you connect me with the reviewing medical director?"

Pharmacy Copay Assistance Application

To Accredo: "I'm starting Voydeya and have an Alexion OneSource copay card. Can you help me apply the maximum assistance and confirm my out-of-pocket cost will be reduced?"

FAQ

Q: How long does Cigna prior authorization take for Voydeya? A: Standard reviews take 72 hours for non-urgent requests, 24 hours for urgent clinical situations. Your prescriber can request expedited review if treatment delays would worsen your condition.

Q: What if Voydeya isn't covered at all by my Cigna plan? A: Request a formulary exception using Cigna's non-covered medication process. Include comprehensive medical necessity documentation and consider external appeal if denied.

Q: Can I use manufacturer copay assistance with Medicare Advantage? A: No, federal law prohibits manufacturer copay cards for government insurance. Explore foundation grants through NORD or Patient Advocate Foundation instead.

Q: Does step therapy apply if I failed other PNH treatments in another state? A: Prior treatment records from any state should count toward step therapy requirements. Ensure your prescriber submits complete documentation of previous trials and outcomes.

Q: How much can the Alexion copay program reduce my costs? A: Up to $15,000 annually for eligible commercial insurance patients. With Tier 4 coinsurance of 25-30%, this could cover most or all out-of-pocket costs depending on your plan.

Q: What happens if I can't afford Voydeya even with assistance? A: Contact Counterforce Health for specialized appeal support, apply for additional foundation grants, and consider New York's external appeal process for financial hardship cases.

About Counterforce Health

Counterforce Health specializes in turning insurance denials into successful appeals for complex specialty medications like Voydeya. Their platform analyzes denial letters, identifies specific coverage criteria, and drafts evidence-based rebuttals tailored to each payer's requirements. For patients facing repeated denials or complex prior authorization challenges, their targeted approach can significantly improve approval odds while reducing the administrative burden on healthcare providers.

This guide provides educational information and should not replace consultation with your healthcare provider or insurance representative. Coverage policies and assistance program eligibility can change. Always verify current requirements directly with Cigna, Alexion, and relevant assistance programs.

Need help with appeals or coverage challenges? Contact Community Health Advocates at 888-614-5400 for free assistance, or visit the NYS Department of Financial Services for external appeal information.

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