Last updated: March 2026
How Much Does Azelastine Nasal Spray (Astelin/Astepro) Cost?
Cost Breakdown by Type
| Type / Procedure | Without Insurance | With Insurance |
|---|---|---|
| 0.1% Nasal Spray Generic (30-day) | $20 – $60 | $0 – $15 |
| 0.15% Astepro OTC (30-day) | $15 – $30 | $15 – $30 |
| Dymista (azelastine/fluticasone combo) | $150 – $300 | $30 – $60 |
What Affects the Cost
- Brand-name vs. generic availability
- Insurance formulary tier placement
- Pharmacy choice (retail vs. mail-order vs. Costco)
- Manufacturer savings cards and coupons
- Dosage and quantity prescribed
- Geographic location
Insurance Coverage
Typical coverage: Generic Tier 2; Astepro now OTC; brand may need prior auth
Most insurance plans use a tiered formulary: Tier 1 (generic) $0-$15 copay, Tier 2 (preferred brand) $25-$75, Tier 3 (non-preferred brand) $50-$150, Tier 4 (specialty) $100-$500+. Prior authorization may be required for certain medications. Step therapy may require trying cheaper alternatives first.
How to Save Money
- Always ask for generic when available — saves 50-90%
- Use GoodRx, RxSaver, or similar discount cards
- Costco pharmacy is open to non-members and often has lowest prices
- Mark Cuban's Cost Plus Drugs offers transparent low pricing
- Manufacturer patient assistance programs provide free medication to qualifying patients
- HSA/FSA funds can cover medication costs tax-free
Related Procedures & Costs
Frequently Asked Questions
Yes, Astepro (azelastine 0.15%) became available OTC. Prescription 0.1% generic and Dymista combination still require a prescription.
Azelastine is an antihistamine spray that works within minutes. Fluticasone is a steroid spray that takes days for full effect. Both are effective; Dymista combines them.
Generic azelastine spray costs $20 to $60/month with a prescription. OTC Astepro costs $15 to $30.