Medicare does cover Brinsupri, but only through a Part D prescription drug plan, and almost always with prior authorization. The drug’s list price runs about $86,000 a year, yet federal law now caps what any Part D enrollee pays out of pocket at $2,100 in 2026, and charitable grants can shrink that further. The question of whether Medicare covers Brinsupri comes down to three things: your plan’s formulary, the prior authorization criteria you’ll need to meet, and the financial assistance you can stack on top of standard Part D benefits.
How Part D Picks Up Brinsupri
Brinsupri (brensocatib) is an oral tablet, which places it under Medicare Part D rather than Part B. Insmed, the manufacturer, directs Medicare beneficiaries to Part D-specific affordability resources on its own patient support site.1Insmed Incorporated. Brinsupri Savings and Support
Coverage still depends on your particular plan. Whether Brinsupri appears on a given Part D or Medicare Advantage drug formulary varies, and plans that do list it generally require prior authorization before they’ll pay. The retail cost of a 30-day supply is roughly $7,171, and no generic exists.2Drugs.com. Brinsupri Price Guide Before enrolling in a plan or filling a first prescription, check that your plan covers the drug and ask what documentation it will require.
What Prior Authorization Will Require
Every major insurer that has published criteria for Brinsupri requires prior authorization. Details vary, but you should expect your prescriber to document the following:
- A confirmed diagnosis of non-cystic fibrosis bronchiectasis, verified by chest CT.
- Cystic fibrosis ruled out by genetic testing or a sweat chloride test.
- A recent history of exacerbations: typically at least two flare-ups requiring antibiotics in the prior 12 months for adults, and at least one for patients aged 12 to 17.3UnitedHealthcare. Prior Authorization Medical Necessity – Brinsupri4Cigna. Cigna National Formulary Coverage Position Criteria – Brinsupri
- A prescription written by, or in consultation with, a pulmonologist.3UnitedHealthcare. Prior Authorization Medical Necessity – Brinsupri
- Non-smoker status, under some plans. Cigna’s national formulary, for example, requires it.4Cigna. Cigna National Formulary Coverage Position Criteria – Brinsupri
Some Medicare Advantage plans add step therapy. Humana, for instance, has required documented failure of macrolide antibiotics such as azithromycin or clarithromycin before approving Brinsupri, with specific dates, doses, and outcomes of those failed treatments.5CounterForce Health. Getting Brensocatib (Brinsupri) Covered by Humana in New York Initial approvals typically last 12 months, with renewals contingent on documented clinical improvement.6Highmark. Pharmacy Policy Bulletin J-1465 – Brinsupri
What You’ll Actually Pay
The sticker price is alarming, but it isn’t what a Medicare beneficiary pays. Thanks to the Inflation Reduction Act, every Part D enrollee has a hard annual cap on out-of-pocket drug spending: $2,000 in 2025, rising to $2,100 for 2026, with inflation adjustments after that. Once your deductible, copays, and coinsurance for covered drugs add up to that amount, you pay nothing more for Part D-covered drugs for the rest of the year. The cap applies automatically, regardless of income.7PAN Foundation. Understanding the Medicare Part D Cap
With a drug priced like Brinsupri, you’d likely hit the cap in your first fill or two. Everything after that is covered.
Spreading the Cost Across the Year
Paying $2,100 in January is still a strain for many retirees. The Medicare Prescription Payment Plan, sometimes called “smoothing,” lets you spread Part D out-of-pocket costs across the calendar year at no extra charge and no interest. You pay nothing at the pharmacy counter and receive a monthly bill from your plan instead. Each month’s bill is the running balance divided by the months left in the year.8Centers for Medicare & Medicaid Services. What’s the Medicare Prescription Payment Plan If you enroll in January and hit the cap early, that works out to roughly $175 a month. Enrolling later means fewer months to divide across, so monthly payments run higher. Smoothing doesn’t lower your total cost; it just makes cash flow predictable.
Extra Help for Lower Incomes
If your income is limited, the Extra Help program (the Low-Income Subsidy) cuts costs much further. In 2026, Extra Help beneficiaries pay no premiums or deductibles and no more than $5.10 for generics or $12.65 for brand-name prescriptions. After total drug costs reach $2,100, they pay nothing.9Centers for Medicare & Medicaid Services. Get Help With Drug Costs For a Brinsupri patient, that typically means a few dollars at most per fill.
Why the Manufacturer Copay Card Won’t Help You
Insmed runs a BRINSUPRI Copay Savings Program that can bring costs to $0 for commercially insured patients. It is explicitly unavailable to anyone enrolled in Medicare, Medicaid, TRICARE, or other federal programs.1Insmed Incorporated. Brinsupri Savings and Support Federal anti-kickback rules prohibit manufacturers from subsidizing copays for patients on government insurance, so this door is closed if you have Medicare.
Charitable Grants That Can Cover Your Share
Independent nonprofit foundations can legally assist Medicare patients. The HealthWell Foundation opened a bronchiectasis fund in December 2025 that covers Medicare enrollees, offering up to $12,000 per year in copayment or Medicare Part B premium assistance. Brinsupri is listed among the covered medications. To qualify, your household income must fall within 300 to 500 percent of the federal poverty level, you must have insurance that covers part of the drug’s cost, and your diagnosis must be verified by a licensed provider.10HealthWell Foundation. Bronchiectasis Fund Since your Part D out-of-pocket maximum is $2,100, a $12,000 award easily covers a full year.
Because Brinsupri is new, dedicated grants from other organizations are still developing. The PAN Foundation and Patient Advocate Foundation are worth checking periodically for bronchiectasis-specific funds.
If Your Plan Denies Coverage
A denial is not the end of the road. You have the right to request exceptions and to appeal.
Formulary and Tiering Exceptions
A formulary exception asks the plan to cover a drug it doesn’t normally list. A tiering exception asks the plan to apply a lower cost-sharing tier to a drug already on the formulary, though drugs on specialty tiers generally cannot be moved down.11Medicare Interactive. Requesting a Tiering Exception Either way, your prescriber must submit a supporting statement explaining why alternatives on the formulary would be less effective or cause harmful side effects. Plans must decide within 72 hours of receiving that statement for a standard request, or 24 hours for an expedited one.12Centers for Medicare & Medicaid Services. Part D Formulary Exceptions
The Five Appeal Levels
If an exception or prior authorization request is denied, Medicare provides five levels of appeal:
- Level 1, plan redetermination, filed within 65 days of the denial. The plan responds within 7 days (standard) or 72 hours (expedited).
- Level 2, independent review by an outside entity, filed within 60 days of the plan’s decision.
- Level 3, hearing before an Administrative Law Judge, filed within 60 days when the amount in dispute meets a minimum threshold ($180 in 2024).
- Level 4, Medicare Appeals Council review, filed within 60 days of the ALJ decision.
- Level 5, federal district court, filed within 60 days when the dispute meets a higher dollar threshold ($1,840 in 2024).13Centers for Medicare & Medicaid Services. Medicare Drug Plan Appeals
Clinical documentation is what wins these appeals. For Brinsupri, that means CT imaging confirming bronchiectasis, records showing the required exacerbations, documentation of any failed prior treatments, and a clear statement from your pulmonologist explaining why this drug is medically necessary. If your plan uses step therapy, include dates, doses, and outcomes for every antibiotic you’ve already tried.