Co-payments for eculizumab and ravulizumab

After eculizumab (Soliris®) was approved in June 2007, a second C5 complement inhibitor has been available for patients with ravulizumab (Ultomiris®) since July 2019. The co-payments differ even more significantly for the new drug than they have been up to now.

The standard dose of eculizumab is 900 mg (3 vials of 300 mg each) every 2 weeks, which leads to an annual additional payment of € 260.00 or € 780.00. The discrepancy is caused by the manufacture of the final infusion. If the pharmacy itself produces the infusion bag from 3 vials of active ingredient and a little sodium chloride solution, the patient only has to pay an additional € 10 per infusion. However, if the pharmacy gives 3 vials with the active ingredient to a clinic and the clinic produces the infusion bag with the drug solution, the patient has to pay an additional € 30 per infusion, i.e. 3 times the amount. If the patient weighs between 60 and 100 kg, ravulizumab is dosed with 3,300 mg (11 vials of 300 mg each) every 8 weeks. A sterile microfilter is used for each infusion, which the patient may have to pay for. This means that the co-payment amount to € 65.00 (without filter) or € 68.90 (with filter) per year if the dispensing pharmacy produces the infusion. In contrast, the production of the infusion solution in the clinic costs € 715.00 (without filter) or € 718.90 (with filter) per year.

That is more than 10 times as much!

A few years ago we made the manufacturer aware of the different co-payments in Germany and asked them to improve the situation, e.g. by introducing another pack size with 3 vials, but nothing has happened so far. Alternatively, each patient can speak to the treating clinics as to whether they will leave the production of the drug to the supplying pharmacy. As with risks and side effects, we recommend: Ask your doctor or pharmacist!

What is your experience? Please let us know by email at or by phone on 030 549094080 how high your co-payments are and in which clinic or practice you are being treated with eculizumab or ravulizumab.

Addition: The annual costs for the drugs are currently € 458,448.90 for eculizumab and € 407,186.78 (for patients weighing 60-100 kg) for ravulizumab.