Myrbetriq costs around $450 per month without insurance for a 30-day supply of 50-milligram tablets. That price tag reflects a combination of factors: it was the first drug in its class when approved, its manufacturer protected it with patents and litigation for over a decade, and the older, cheaper alternatives come with side effects that make Myrbetriq worth the premium for many patients. The good news is that generic versions have recently hit the market, which should bring prices down significantly.
It Was the First Drug of Its Kind
Myrbetriq (mirabegron) works through a completely different mechanism than the older overactive bladder drugs most people are familiar with. While traditional medications block a specific nerve signal to reduce bladder contractions, Myrbetriq activates a different receptor that relaxes the bladder muscle to help it hold more urine. When the FDA approved it in 2012, it was the only drug using this approach, giving its manufacturer, Astellas Pharma, a unique product with no direct competition.
First-in-class drugs almost always carry premium prices. The company that develops a novel mechanism invests heavily in research, clinical trials, and regulatory approval with no guarantee of success. That upfront investment gets built into the price, and without competitors offering the same type of treatment, there’s no market pressure to lower it.
Patent Litigation Kept Generics Off the Market
Several generic drugmakers, including Sandoz, Zydus, and Lupin, filed applications with the FDA to sell cheaper versions of Myrbetriq back in 2016. Astellas responded by suing all of them for patent infringement. The parties initially reached a settlement and the cases were dismissed, but Astellas sued again in November 2020 when a new patent was issued, restarting the legal battle in federal court.
This pattern is common in the pharmaceutical industry. Brand-name manufacturers use patents and the litigation process to extend their period of market exclusivity, sometimes by years. Each lawsuit triggers an automatic delay before the FDA can approve a generic, effectively keeping the brand-name version as the only option and its price intact. For Myrbetriq, this legal back-and-forth meant patients paid brand-name prices for over a decade after the drug’s initial approval.
Generics Are Now Available
The FDA has approved generic mirabegron, and multiple versions are already on the market. Zydus Pharmaceuticals began selling its generic in January 2024, followed by Lupin Pharmaceuticals in April 2024. Additional generic manufacturers, including Qilu Pharmaceutical, have 2025 launch dates. As more companies enter the market, competition should continue pushing prices lower.
If you’re currently paying full price for brand-name Myrbetriq, ask your pharmacist whether a generic version is available at your pharmacy. Generic drugs contain the same active ingredient at the same dose and must meet the same FDA standards for effectiveness, so the therapeutic difference is negligible. The cost difference, however, can be substantial.
Cheaper Alternatives Have Serious Drawbacks
One reason Myrbetriq commands a high price is that the older, cheaper overactive bladder drugs belong to a class called anticholinergics, and they come with a side effect profile that many patients and doctors want to avoid. Dry mouth is three to nearly eight times more likely with these older drugs compared to a placebo. Constipation is two to nearly five times more likely. Those may sound minor, but for people taking the medication daily and indefinitely, they’re common reasons patients stop treatment.
The more concerning issue is what anticholinergics do to the brain. Studies have linked cumulative use of these medications to delirium, cognitive impairment, confusion, and an increased risk of dementia. This is especially alarming for older adults, who are both the most likely to need overactive bladder treatment and the most vulnerable to cognitive decline. Myrbetriq does not carry this anticholinergic burden, which makes it the preferred choice for older patients even at a higher price point.
Myrbetriq showed no increased risk of dry mouth or constipation compared to placebo in clinical trials, giving it a meaningfully better tolerability profile. For many patients, paying more for a drug they can actually stay on long-term is more cost-effective than cycling through cheaper medications they quit due to side effects.
Limited Competition in Its Drug Class
For years, Myrbetriq was the only drug using its mechanism of action. A second drug in the same class, vibegron (sold as Gemtesa), eventually received FDA approval, but it’s also a brand-name medication without a generic. A cost-effectiveness analysis found that vibegron actually had the highest total pharmacy costs among overactive bladder treatments, though it was associated with the lowest costs related to side effects and complications from anticholinergic burden.
With only two brand-name drugs in this newer class, neither company faces the kind of competitive pressure that drives prices down. Both can price at a premium because the alternative for patients is going back to the older anticholinergic drugs, which many people either can’t tolerate or shouldn’t take.
What Insurance Typically Covers
If you have Medicare Part D, Myrbetriq generally falls into tier 2 or tier 3, depending on your specific plan. Tier 2 drugs carry medium copayments, while tier 3 copayments are higher. Your out-of-pocket cost varies widely based on your plan’s formulary, your deductible, and which phase of coverage you’re in.
Some insurance plans may require you to try a cheaper anticholinergic medication first before they’ll cover Myrbetriq, a practice called step therapy. If the older drug causes intolerable side effects or doesn’t work, your doctor can request a prior authorization to get Myrbetriq covered. With generics now on the market, insurers may also steer coverage toward generic mirabegron rather than the brand-name version, which would lower your copay while giving you the same medication.