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Savings and Affordability

What Can I Expect to Pay for ULTOMIRIS®?

Pay as
little as



if you have commercial insurance*

Additional eligibility requirements apply; see Terms and Conditions.

If you are starting treatment with ULTOMIRIS, but are concerned about how to pay for it, we may be able to help

Typically, you will pay a copay or coinsurance for the visit when you receive your ULTOMIRIS dose. There may or may not be additional fees for the infusion itself depending on your health plan. The table below outlines out-of-pocket (OOP) expenses by insurance type.

Insurance Types

OOP Expenses

OOP Maximums

Private insurance

Deductibles and your copayment/
coinsurance will vary by insurance plan, although you are likely to have a coinsurance for ULTOMIRIS and the administration of it.

Your plan will have an OOP maximum for a plan year.

Medicare Part B

After the annual deductible is paid, you will usually pay 20% of the cost of ULTOMIRIS and 20% for each infusion.

However, supplemental insurance such as Medigap will help cover all or a portion of these costs.

Over 90% of Medicare patients have some type of supplemental insurance, which reduces OOP costs for infusions.

No OOP maximum.

Medicare Part C

Your deductible and copayment/
coinsurance will vary by insurance plan.

Your Medicare plan has an annual OOP maximum.

Medicare Part D

You may have 4 different phases of coverage in Part D, including a deductible, an initial coverage phase, donut hole, and catastrophic coverage.

There is no true OOP maximum in Part D. Once you get to catastrophic coverage, you may pay 5% for the remainder of the plan year.

Alexion OneSource CoPay Program

The Alexion OneSource™ CoPay Program helps people pay for eligible out-of-pocket medication and infusion costs

Program Eligibility

Patient enrolled in OneSource

Patient with commercial insurance who has a valid prescription for a US FDA–approved indication for ULTOMIRIS (ravulizumab-cwvz)

Patient must reside and receive treatment with ULTOMIRIS in the United States or its territories

How to Apply for the Alexion OneSource CoPay Program

Fill out the Alexion OneSource Enrollment Form

The Enrollment Form can be found at

Submit form

Simply fill out the form online, or send the printed form to OneSource at You can always call OneSource at 1-877-464-8586 if you have questions while completing or submitting the form

Receive CoPay ID number from OneSource

You will receive communication from OneSource containing the CoPay ID number

Provide CoPay ID number to site of care

Remember, you can always call OneSource with any questions about the CoPay Program

Navigating your health plan’s approval process for ULTOMIRIS

After you are prescribed ULTOMIRIS, your doctor’s office may research your health plan’s coverage, a process called a Benefits Investigation. OneSource, Alexion’s personalized patient support program, can also conduct a simultaneous Benefits Investigation to make sure that there is complete understanding of your insurance benefits. After a Benefits Investigation, you and your doctor can have a complete picture of ULTOMIRIS coverage and will understand any requirements to access ULTOMIRIS and your OOP costs for ULTOMIRIS.

The Benefits Investigation helps you and your doctor’s office understand:

Current Coverage

Your current coverage for ULTOMIRIS


Requirements your insurance company or health plan has to get ULTOMIRIS approved such as a Prior Authorization or a Letter of Medical Necessity

Coverage Restrictions

If there are any coverage restrictions such as the need for a referral or staying within network


Whether your insurance company requires you to receive ULTOMIRIS at a particular site of care including: the hospital, doctor’s office, infusion center, or through a home infusion benefit that allows you to receive ULTOMIRIS at home

Medical Exception

If you need to file a request for a Medical Exception

Out-of-Pocket Costs

Your OOP costs and information about your deductible, copayment, coinsurance, and annual OOP maximum with your plan

Want to learn more about savings and affordability with ULTOMIRIS? Download this comprehensive insurance guide

Download the market access brochure

Want to learn more about support with OneSource?
Call us at 1-877-GMG-ULTO (877-464-8586)

Receive information and updates


What is the most important information I should know about ULTOMIRIS?
ULTOMIRIS is a medicine that affects your immune system and may lower the ability of your immune system to fight infections.

  • ULTOMIRIS increases your chance of getting serious meningococcal infections that may quickly become life-threatening or cause death if not recognized and treated early.
  1. You must complete or update meningococcal vaccine(s) at least 2 weeks before your first dose of ULTOMIRIS.
  2. If you have not completed your meningococcal vaccines and ULTOMIRIS must be started right away, you should receive the required vaccine(s) as soon as possible.
  3. If you have not been vaccinated and ULTOMIRIS must be started right away, you should also receive antibiotics for as long as your healthcare provider tells you.
  4. If you had a meningococcal vaccine in the past, you might need additional vaccines before starting ULTOMIRIS. Your healthcare provider will decide if you need additional meningococcal vaccines.
  5. Meningococcal vaccines do not prevent all meningococcal infections. Call your healthcare provider or get emergency medical care right away if you get any of these signs and symptoms of a meningococcal infection: fever, fever with high heart rate, headache and fever, confusion, muscle aches with flu-like symptoms, fever and a rash, headache with nausea or vomiting, headache with a stiff neck or stiff back, or eyes sensitive to light.

Your healthcare provider will give you a Patient Safety Card about the risk of serious meningococcal infection. Carry it with you at all times during treatment and for 8 months after your last ULTOMIRIS dose. Your risk of meningococcal infection may continue for several months after your last dose of ULTOMIRIS. It is important to show this card to any healthcare provider who treats you. This will help them diagnose and treat you quickly.

ULTOMIRIS is only available through a program called the ULTOMIRIS and SOLIRIS Risk Evaluation and Mitigation Strategy (REMS). Before you can receive ULTOMIRIS, your healthcare provider must: enroll in the REMS program; counsel you about the risk of serious meningococcal infections; give you information about the signs and symptoms of serious meningococcal infection; make sure that you are vaccinated against serious infections caused by meningococcal bacteria, and that you receive antibiotics if you need to start ULTOMIRIS right away and are not up to date on your vaccines; give you a Patient Safety Card about your risk of meningococcal infection.

ULTOMIRIS may also increase the risk of other types of serious infections, including Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria gonorrhoeae. Certain people may be at risk of serious infections with gonorrhea.

Who should not receive ULTOMIRIS?
Do not receive ULTOMIRIS if you have a serious meningococcal infection when you are starting ULTOMIRIS.

Before you receive ULTOMIRIS, tell your healthcare provider about all of your medical conditions, including if you: have an infection or fever, are pregnant or plan to become pregnant, and are breastfeeding or plan to breastfeed. It is not known if ULTOMIRIS will harm your unborn baby or if it passes into your breast milk. You should not breastfeed during treatment and for 8 months after your final dose of ULTOMIRIS.

Tell your healthcare provider about all the vaccines you receive and medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements which could affect your treatment.

What are the possible side effects of ULTOMIRIS?
ULTOMIRIS can cause serious side effects including infusion-related reactions. Symptoms of an infusion-related reaction with ULTOMIRIS may include lower back pain, abdominal pain, muscle spasms, changes in blood pressure, tiredness, feeling faint, shaking chills (rigors), discomfort in your arms or legs, bad taste, or drowsiness. Stop treatment of ULTOMIRIS and tell your healthcare provider right away if you develop these symptoms, or any other symptoms during your ULTOMIRIS infusion that may mean you are having a serious infusion-related reaction, including: chest pain, trouble breathing or shortness of breath, swelling of your face, tongue, or throat, and feel faint or pass out.

The most common side effects of ULTOMIRIS in people with gMG are diarrhea and upper respiratory tract infections.

Tell your healthcare provider about any side effect that bothers you or that does not go away. These are not all the possible side effects of ULTOMIRIS. For more information, ask your healthcare provider or pharmacist. Call your healthcare provider right away if you miss an ULTOMIRIS infusion or for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


ULTOMIRIS is a prescription medicine used to treat adults with a disease called generalized Myasthenia Gravis (gMG) who are anti-acetylcholine receptor (AChR) antibody positive. It is not known if ULTOMIRIS is safe and effective for the treatment of gMG in children.

Please see the full Prescribing Information and Medication Guide for ULTOMIRIS, including Boxed WARNING regarding serious meningococcal infections.

Questions? Call us at 1-877-GMG-ULTO (877-464-8586)