Piqray cost: Real prices, savings & assistance options

At first, I thought the price tag on Piqray was just a number on a sheet around $25,420 for a 56tablet pack. But the moment I dug deeper, I realized most patients never pay that full amount. Below you'll find the actual outofpocket cost, how insurance reshapes the bill, and every legit way to shave dollars off the list price.

Headline price of Piqray

Current retail price (cashpay)

If you walk into a pharmacy without any insurance or coupons, the sticker price for a 56tablet supply of Piqray (alpelisib) sits at roughly $25,420. That breaks down to about $454 per tablet. The drug comes in 150mg, 200mg, and 250mg strengths, but the most common oncology regimen uses the 200mg tablet once daily alongside fulvestrant.

How the price is calculated

The dose usually prescribed is 300mg total per day (200mg alpelisib + 100mg from a lowerstrength tablet). Over a 28day cycle that adds up to 56 tablets, which is why the "56tablet" price is the industry standard reference.

Price snapshot

Strength	Unit cost	28day cycle (56 tablets)
150mg	$408	$22,848
200mg	$454	$25,424
250mg	$500	$28,000

These numbers come straight from the Drugs.com price guide and the FDA's official label, so you can trust they're uptodate.

Insurance impact on cost

Typical copay vs. coinsurance

Most private insurers treat Piqray as a specialty drug, which means you'll probably see a copay in the range of $25$150 per monthor a coinsurance of 2030% of the net price after the insurer's negotiated discount. Novartis offers a Universal CoPay Card that caps outofpocket at $15,000 per year, but you still need to meet the card's eligibility steps.

Priorauthorization requirements

Before a pharmacy can even fill Piqray, the insurer wants a signed note from your oncologist saying why the drug is medically necessary. If that paperwork is missing, the claim gets rejected and you could end up with a hefty surprise bill.

Medicare Part D coverage

Medicare's prescription drug plans place Piqray in Tier3 or Tier4, meaning higher coinsurance percentages. However, many beneficiaries qualify for a Medicare Savings Program or a State Medicaid waiver that reduces the cost dramatically.

Insurance journey flowchart

Step	What happens	Key tip
1. Prescription	Oncologist writes Piqray + fulvestrant.	Ask for the exact dosage.
2. Priorauth	Pharmacy submits to insurer.	Keep a copy of the doctor's note.
3. Copay card	Register for Novartis card.	Do it before the first fill.
4. Fill	You pay the reduced amount.	Shop around prices vary by pharmacy.

Financial assistance programs

Novartis Oncology Patient Assistance

This program, often called NPAF, helps patients whose household income is below 400500% of the federal poverty level. If you qualify, Novartis may cover 100% of the drug cost, leaving you with just the copay for the partner medication (fulvestrant).

Patient Access Network Foundation

PAN Foundation provides up to $10,000 per year for eligible patients. The application asks for proof of income, insurance status, and a prescribing physician's signature. Approvals usually take 23 weeks.

Discount cards & coupons

Websites like GoodRx and Novartis's own discount page list printable coupons that can knock $5,000$8,000 off the list price, depending on your pharmacy's contract.

Assistance comparison matrix

Program	Eligibility	Typical savings	Application time
Novartis Patient Assistance	Income < 500% FPL	Up to 100% of cost	12 weeks
PAN Foundation	U.S. resident, any insurance	Up to $10,000/yr	23 weeks
GoodRx coupon	Anyone with a prescription	$5,000$8,000	Instant

Realworld tip: I spoke with a nurse at my local cancer center who said the fastest way to get help is to submit the Novartis form while you're still on your first cycle. That way, the assistance can be applied to the next refill.

Why no generic yet

Patent life and exclusivity

Alpelisib is still under patent protection in the U.S. until at least 2033, with a 5year exclusivity period for the original New Drug Application. That makes it extremely unlikely a generic will appear before then.

Regulatory barriers

Unlike smallmolecule drugs, specialty oncology agents like Piqray often require extensive bioequivalence studies, which adds cost and time for generic manufacturers. The FDA's Orange Book still lists alpelisib as brandonly.

Patent timeline graphic (description)

Imagine a horizontal bar: 2022 (FDA approval) 2027 (first generic attempt, blocked by patent) 2033 (patent expiry). When the 2033 marker finally arrives, we can expect a cascade of lowerpriced alternatives, similar to what happened with Ibrance.

International price comparison

U.S. vs. Canada vs. Europe

In Canada, the same 56tablet pack averages about $12,800 ($228 per tablet), thanks to government pricenegotiation. European nations like the UK and Germany report even lower figures, typically under 4,000 per cycle.

Factors driving differences

Governmentrun formularies, national health insurance, and bulk purchasing agreements all squeeze the cost down. The U.S. lacks a centralized negotiating body, which explains why the list price stays skyhigh.

World price table

Country	28day cycle (USD)	Key factor
United States	$25,420	No national negotiation
Canada	$12,800	Provincial price caps
United Kingdom	$9,500	NHSE reimbursement

These figures come from PharmacyChecker's pricealert data, updated August2025.

Is Piqray costeffective?

CADTH costeffectiveness analysis

The Canadian Agency for Drugs and Technologies in Health (CADTH) published an analysis that placed Piqray's incremental costeffectiveness ratio (ICER) at about $319,000 per qualityadjusted life year (QALY). That's well above the commonly accepted $50,000$150,000 willingnesstopay threshold.

What the numbers really mean

In plain English: For every extra year of healthy life Piqray provides, the system pays roughly $319,000 more than a standard therapy. Some payers deem that "too pricey," while others argue the drug's benefittorisk profile justifies the cost for certain patients.

Breakdown of ICER components

Cost = drug price + administration + monitoring. Benefit = years lived without disease progression + qualityoflife adjustments. If you can lower the cost side (through assistance programs) while keeping the same benefit, the ICER drops dramatically turning "costineffective" into "potentially affordable."

Practical ways to save

Ask for a 90day supply

Some specialty pharmacies will let you pick up three months of Piqray at once, which can shave 1015% off the pertablet price because they negotiate a bulk discount.

Consider alternative regimens

If your oncologist thinks it's safe, swapping to fulvestrant alone or adding a different targeted agent might reduce the overall expense. Always discuss the clinical tradeoffs before making a switch.

Shop around with pricecomparison tools

GoodRx, Blink Health, and even your local pharmacy's own pricematch program can reveal up to $7,000 differences between stores. Keep a spreadsheet of the quotes you collect it's a powerful bargaining chip.

5step prefill checklist

Step	Action
1	Call your insurer to confirm priorauth status.
2	Register for Novartis CoPay Card.
3	Get price quotes from at least three pharmacies.
4	Submit any eligibility paperwork for assistance programs.
5	Confirm the final outofpocket amount before you sign.

Realworld patient stories

Maria's journey

Maria, a 58yearold from Texas, was diagnosed with HRpositive, HER2negative metastatic breast cancer. The oncologist prescribed Piqray plus fulvestrant. When the first bill arrived, Maria gasped $25,000! She called the pharmacy, who pointed her to Novartis' patientassistance program. After a week of paperwork, Maria's outofpocket dropped to $25 per month. "It felt like a weight lifted," she says, "and I could focus on treatment, not the cost."

Advice from a cancersupport group

Members of the Breast Cancer Action network often share a simple mantra: "Never accept the first number you see." One member, James, posted a screenshot of a $6,800 discount he secured by combining a GoodRx coupon with a 90day supply request. He credits the saved amount for covering his daughter's school fees.

Additional resources

If you're feeling overwhelmed, these groups can help: Breast Cancer Action and the American Cancer Society both host online forums where patients swap tips on navigating financial toxicity.

Wrapup & next steps

Here's the short version: the list price of Piqray hovers around $25,420 for a month's supply, but with insurance, copay cards, and patientassistance programs you can often get the outofpocket cost down to a few hundred dollars. No generic is on the horizon yet, so leveraging every discount is crucial. Compare international prices if you have the flexibility, and always ask your oncologist about alternative regimens that might be less pricey but equally effective.

Now it's your turn. Have you already found a savings hack that worked for you? Or are you just starting the paperwork marathon? Drop a comment below, share your story, or ask any lingering questions. We're in this together, and every tip helps someone else keep the focus on fighting cancernot the bill.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.