Keytruda® Medicare Coverage

Keytruda®
Chemical name: Vedolizumab

Typical dosage: 50mg

Typical type: Injection1

Keytruda® is a prescription medication used to treat certain cancers such as melanoma, non-small cell lung cancer (NSCLC), head and neck squamous cell cancer (HNSCC), classical Hodgkin lymphoma (cHL) among other cancers. This is an injectable medication that is currently available as a brand-only medication.

Keytruda is an immunotherapy used to treat several types of cancers. It works by stimulating the immune system to attack cancer cells.

Keytruda is administered intravenously at a doctor’s office or infusion center over 30 minutes usually every 3 weeks. Because this medication works on the immune system, it can attack normal organs and tissues in the body during treatment or even after treatment ends, which can be severe or life-threatening.

Common side effects of this medication include fatigue, pain, diarrhea, constipation, decreased appetite, nausea and rash.

Does Medicare cover Keytruda?

No. Medicare Advantage plans and Medicare Part D plans do not typically cover Keytruda.1

You may be able to find Medicare Advantage plans or Part D plans that cover other cancer treatment drugs.

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability.

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Average costs for Keytruda with Medicare drug coverage1

Because Medicare Advantage plans and Medicare Part D plans do not typically cover Keytruda, you will likely be responsible for all costs for this drug if you have one of these types of Medicare coverage.

Additional information

Keytruda is indicated to treat several types of advanced cancers and is not a chemotherapy drug, but an immunotherapy drug.

This immunotherapy agent has been shown to significantly shrink tumors, reduce disease progression and even help patients extend their life.

Keytruda has been labeled as breakthrough therapy in certain advanced cancers and has received accelerated approval by the FDA in certain cancers because of the significant benefit of this medication seen in clinical trials.

Keytruda should be used with caution in patients with immune problems, organ transplant, stem cell transplant, liver or lung problems.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Keytruda. Retrieved May 2019, from www.goodrx.com/keytruda.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.