When Nexium is not covered by your insurance plan it can be quite expensive. The idea obviously is not to have to pay out of pocket but sometimes this can't be avoided. Nexium 40 mg, which is a standard dose, runs nearly $6.00 per pill. This is the list price from American wholesale giant Costco. This means that a standard supply of pills will run from $300 to $600 dollars out of pocket for 50 to 100 pills. This pill can be obtained from other countries, such as Canada and Australia, for a much cheaper price. But as of this writing this is not legal in the United States.