Veozah is the brand name for fezolinetant, a selective neurokinin 3 (NK3) receptor antagonist made by Astellas Pharma. The FDA approved Veozah on May 12, 2023, as the first non-hormonal treatment specifically for moderate to severe vasomotor symptoms (hot flashes and night sweats) associated with menopause. Unlike hormone replacement therapy, Veozah works by blocking NK3 receptors in the hypothalamus that regulate body temperature, making it an option for patients who cannot or prefer not to use estrogen-based treatment because of a history of breast cancer, blood clots, or other contraindications.
Astellas set Veozah's wholesale acquisition cost (list price) at approximately $550 per month at its 2023 launch, or about $6,600 per year. By 2026, the average cash price patients see at the pharmacy counter has climbed to roughly $700 to $780 per month, with some pharmacies charging over $1,000 depending on ZIP code and local markup. What you actually pay depends heavily on your insurance status, your plan's formulary tier, and whether you use the manufacturer savings card or patient assistance program described below. Because Veozah requires liver function blood tests before starting and periodically during treatment, patients should also budget for lab costs separate from the drug itself, an easy-to-miss expense when comparing prices.
Veozah has not been selected for Medicare drug price negotiation under the Inflation Reduction Act of 2022. The first 10 negotiated drugs (Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/NovoLog) reached negotiated Maximum Fair Prices effective January 1, 2026, and a second round covering semaglutide products is scheduled for 2027. Veozah is too new and too small in overall Medicare spending to qualify for the current negotiation rounds, which are based on total Medicare Part D spending. That means Medicare beneficiaries taking Veozah pay standard Part D cost-sharing rather than a negotiated price, subject to the general 2026 $2,100 annual out-of-pocket cap.
What Veozah Costs by Point of Pay (2026)
The price you pay depends almost entirely on WHERE you pay. The same veozah can cost many times more at a hospital than at your local pharmacy:
2026 Veozah Price by Point of Pay| Where you pay | Typical cost | Notes |
|---|
| Pharmacy counter (retail, cash) | $650 - $1,013/month | No insurance, no coupon. Price varies significantly by pharmacy and ZIP code. |
| Medicare Part D (2026) | Tier 3-4 copay, capped at $2,100/year | Not all plans cover Veozah. Prior authorization is common; not IRA price-negotiated. |
| Commercial insurance | $30 - $150/month after PA | Formulary tier 3 or 4 is typical; step therapy toward hormone therapy is sometimes required first. |
| Astellas Veozah Savings Card | $0 first month, then $30/month (up to $4,000/year) | Commercial insurance only. Blocked by law for Medicare, Medicaid, TRICARE, and VA beneficiaries. |
| Medicaid | $1 - $4/prescription, with PA | Coverage and formulary placement vary by state Medicaid program. |
Retail prices reflect 2026 GoodRx, SingleCare, and pharmacy survey data. Part D copays depend on your plan's formulary tier and where you are in your benefit year.
Source: CMS Part D 2026 benefit design, Astellas Veozah Support Solutions, GoodRx, SingleCare
Why Hospitals Charge So Much
Veozah is an outpatient, self-administered oral tablet, so it rarely appears on an inpatient hospital bill. When it does, usually because a hospital pharmacy dispensed a short-term supply during an admission or observation stay, the charge can run several times the retail cash price. Hospital pharmacies typically add facility fees, dispensing fees, and administrative markups on top of their own acquisition cost for the drug.
Astellas' 2023 wholesale acquisition cost for Veozah was about $550 per month. If an itemized inpatient bill shows Veozah priced at $1,500 or more for a partial month's supply, ask the hospital billing department for the line-item National Drug Code (NDC) and compare it against the wholesale rate. Most commercial insurance and Medicare Part D plans will only reimburse the outpatient pharmacy benefit rate for a self-administered drug like Veozah, which means an inpatient markup often falls on the patient unless it is disputed through the hospital's billing office or a medical bill analyzer.
Patient Assistance Programs
Astellas Pharma, the manufacturer of Veozah, runs two separate programs depending on your insurance status. If you have no insurance at all, the retail price of $650 to $1,013 per month makes the manufacturer patient assistance program the most important cost-saving option to check before paying cash.
Patient assistance programs for Veozah| Manufacturer program | Cost / Benefit | How to apply |
|---|
| Veozah Savings Card | $0 for the first monthly fill, then as little as $30/month for commercially-insured patients (up to $4,000/year) | veozahsavings.com |
| Astellas Patient Assistance Program | Veozah at no cost for eligible patients with no prescription drug coverage | veozahaccess.com |
| NeedyMeds Drug Discount Card | Variable discount accepted at most US pharmacies as a backup option | needymeds.org |
The Veozah Savings Card is not valid for patients whose prescription claims are reimbursed in whole or in part by Medicare, Medicaid, TRICARE, VA, DoD, or any other state or federal healthcare program, under federal anti-kickback law (42 U.S.C. § 1320a-7b). If you have government insurance, apply for the Astellas Patient Assistance Program instead, which is a manufacturer coupon alternative built for that population.
Source: Astellas Veozah Support Solutions, NeedyMeds.org
Medicare Part D
Medicare Part D plans decide individually whether to cover Veozah, and not every plan includes it on its formulary. When a plan does cover Veozah, it typically sits on formulary tier 3 or tier 4, which carries a higher copay or coinsurance than generic or preferred-brand tiers. Prior authorization is common, often approved for a 12-month period once granted, and some plans require documentation that hormone therapy is contraindicated or has already failed before approving Veozah.
For 2026, your total annual out-of-pocket cost across all Part D drugs combined, including Veozah, is capped at $2,100 under the Inflation Reduction Act. Once you reach that cap in a calendar year, you pay $0 for the rest of the year on covered Part D drugs. Because Veozah has not gone through Medicare price negotiation, your specific copay before hitting the cap depends entirely on your plan's negotiated rate and formulary tier rather than a government-set Maximum Fair Price.
The Medicare Prescription Payment Plan, available since 2025, lets you spread your Part D out-of-pocket costs evenly across the calendar year instead of paying a large amount up front. If a high Veozah copay early in the year is a hardship, ask your Part D plan to enroll you in this payment plan so the cost is billed in smaller monthly installments instead.
Common Veozah Billing Errors
If you received a bill for Veozah above $150/month with commercial insurance, or a denial without explanation on Medicare Part D, check for these issues before paying:
- Prior authorization not submitted: most commercial and Part D plans require PA for Veozah. If your prescriber's office never filed the paperwork, the pharmacy may be running the claim as a cash sale by default.
- Savings card not applied at the pharmacy counter despite commercial insurance eligibility. Ask the pharmacist to rerun the claim with the Veozah Savings Card BIN/PCN before paying full price.
- Liver function blood tests billed as a separate specialty lab panel at facility rates, rather than through your primary care visit or a lower-cost lab. Veozah requires ALT/AST monitoring before starting and periodically afterward; ask where the cheapest in-network lab location is before scheduling.
- Charged full Part D cost-sharing after you already hit the $2,100 annual out-of-pocket cap for 2026.
- Astellas Patient Assistance Program approval not communicated to the dispensing pharmacy, resulting in a cash charge even though the patient was already approved for free medication.
Frequently Asked Questions
Is there a generic version of Veozah?
No. As of 2026, there is no generic fezolinetant available. Veozah launched in 2023 and is protected by patents that remain open to legal challenge starting in May 2027, with FDA new chemical entity exclusivity running through 2028. Industry analysts project the earliest possible generic launch around March 2034. Because Veozah is a small-molecule tablet rather than a biologic, competition will come from a generic manufacturer, not a biosimilar.
How do I apply for the Astellas Veozah patient assistance program?
Visit veozahaccess.com or call 1-866-239-1637 (Monday through Friday, 8 AM to 8 PM ET) to start an application. You will need to show proof of no prescription drug coverage, provide your prescriber's contact information, and submit a completed enrollment form. If approved, Astellas ships Veozah at no cost directly to you or your prescriber's office, with periodic reverification required.
Can I use the Veozah savings card with Medicare?
No. Federal anti-kickback law (42 U.S.C. § 1320a-7b) bars manufacturer copay savings cards, including the Veozah Savings Card, from being used by anyone covered by Medicare, Medicaid, TRICARE, VA, or another government health program. The savings card is for commercially-insured patients only and drops the cost to $0 for the first fill and $30 per month after. If you have Medicare, apply for the separate Astellas Patient Assistance Program instead.
What if my insurance denies coverage for Veozah?
Request the written denial notice, then file a formal appeal within the stated deadline (usually 60 to 180 days) with supporting clinical notes from your prescriber. If your plan requires step therapy toward hormone replacement therapy first, ask your prescriber to file an override request if hormone therapy is medically contraindicated for you. If the appeal fails, request an external review through your state Department of Insurance, and apply for the Astellas Patient Assistance Program in the meantime.
Does the IRA negotiated Medicare price apply to Veozah?
No. Veozah has not been selected for any round of Medicare drug price negotiation under the Inflation Reduction Act of 2022. The first 10 negotiated drugs reached Maximum Fair Prices effective January 1, 2026, and a second round covering semaglutide products takes effect in 2027. Veozah does not yet have enough total Medicare Part D spending to qualify for selection. Medicare beneficiaries pay standard Part D cost-sharing for Veozah, capped at $2,100 total out-of-pocket across all Part D drugs in 2026.
What does Veozah cost without insurance at the pharmacy counter in 2026?
Cash retail prices for a 30-day supply of Veozah 45mg tablets range from about $650 to $1,013 depending on the pharmacy and ZIP code, with an average around $700 to $780. Coupon-adjusted prices bring the cost down to roughly $467 to $603 at chains like Kroger, CVS, Walgreens, and Walmart. GoodRx and SingleCare coupons are the fastest way to lower the price without insurance.
Do I qualify for the Astellas Veozah patient assistance program?
Astellas does not publish a specific income threshold or federal poverty level percentage for the Veozah patient assistance program online. Eligibility generally requires that you have no prescription drug coverage (or coverage that excludes Veozah), a valid US shipping address, and a prescription for the FDA-approved indication. The fastest way to confirm your eligibility is to call 1-866-239-1637 or apply directly at veozahaccess.com.
How is Veozah different from hormone replacement therapy for hot flashes?
Veozah (fezolinetant) is non-hormonal, working by blocking NK3 receptors in the brain that regulate body temperature, while hormone replacement therapy (HRT) uses estrogen, with or without progesterone, to replace declining hormone levels. Veozah is an option for patients who cannot use HRT due to a history of breast cancer, blood clots, or other estrogen-related contraindications. Generic HRT options are typically far cheaper than Veozah, so many insurance plans require patients to try HRT first through step therapy before approving Veozah.
