See the DrugPatentWatch profile for keytruda

Is Keytruda Covered by Insurance? A Comprehensive Guide

What is Keytruda?

Keytruda, also known as pembrolizumab, is a medication used to treat various types of cancer, including melanoma, lung cancer, and head and neck cancer. It is a type of immunotherapy that works by boosting the body's natural defenses to fight cancer cells.

Is Keytruda Covered by Insurance?

The answer to this question is not a simple yes or no. Keytruda is a prescription medication, and its coverage by insurance depends on several factors, including the type of insurance plan, the patient's medical history, and the specific cancer being treated.

Coverage by Medicare

Medicare Part B covers Keytruda for certain types of cancer, including melanoma, non-small cell lung cancer, and head and neck cancer. However, patients may need to pay a 20% coinsurance for each infusion, which can range from $1,000 to $2,000 per treatment.

Coverage by Medicaid

Medicaid coverage for Keytruda varies by state. Some states cover Keytruda for certain types of cancer, while others may not. Patients should check with their state Medicaid program to determine coverage.

Coverage by Private Insurance

Private insurance plans, including employer-sponsored plans and individual plans, may cover Keytruda for certain types of cancer. However, coverage and copays can vary widely depending on the plan and the patient's medical history.

Cost of Keytruda

The cost of Keytruda can be significant, with a single treatment costing around $12,000 to $15,000. Over the course of treatment, which can last several months or even years, the total cost can range from $50,000 to $200,000 or more.

Patient Assistance Programs

For patients who are unable to afford Keytruda, there are several patient assistance programs (PAPs) available. These programs, offered by the manufacturer, Merck, and other organizations, can help patients access the medication at a reduced cost or even for free.

Keytruda Coverage by Insurance Company

Here is a breakdown of Keytruda coverage by some of the largest insurance companies in the United States:

* Aetna: Covers Keytruda for certain types of cancer, with a copay of around $50 to $100 per treatment.
* Cigna: Covers Keytruda for certain types of cancer, with a copay of around $50 to $100 per treatment.
* UnitedHealthcare: Covers Keytruda for certain types of cancer, with a copay of around $50 to $100 per treatment.
* Humana: Covers Keytruda for certain types of cancer, with a copay of around $50 to $100 per treatment.

Conclusion

In conclusion, Keytruda coverage by insurance is complex and depends on several factors, including the type of insurance plan, the patient's medical history, and the specific cancer being treated. Patients should check with their insurance provider to determine coverage and copays. Additionally, patient assistance programs may be available to help patients access the medication at a reduced cost or even for free.

Key Takeaways

* Keytruda is a prescription medication used to treat various types of cancer.
* Coverage by insurance depends on several factors, including the type of insurance plan, the patient's medical history, and the specific cancer being treated.
* Medicare Part B covers Keytruda for certain types of cancer, while Medicaid coverage varies by state.
* Private insurance plans may cover Keytruda, but coverage and copays can vary widely.
* Patient assistance programs may be available to help patients access the medication at a reduced cost or even for free.

Frequently Asked Questions

Q: Is Keytruda covered by Medicare?

A: Yes, Medicare Part B covers Keytruda for certain types of cancer, including melanoma, non-small cell lung cancer, and head and neck cancer.

Q: Is Keytruda covered by Medicaid?

A: Coverage by Medicaid varies by state. Patients should check with their state Medicaid program to determine coverage.

Q: Is Keytruda covered by private insurance?

A: Private insurance plans may cover Keytruda, but coverage and copays can vary widely depending on the plan and the patient's medical history.

Q: How much does Keytruda cost?

A: The cost of Keytruda can range from $12,000 to $15,000 per treatment, with a total cost of $50,000 to $200,000 or more over the course of treatment.

Q: Are there patient assistance programs available for Keytruda?

A: Yes, there are several patient assistance programs available to help patients access Keytruda at a reduced cost or even for free.

Sources

1. Merck. (n.d.). Keytruda. Retrieved from <https://www.merck.com/product/usa/picirculars/k/keytruda/keytrudapi.pdf>
2. DrugPatentWatch.com. (n.d.). Pembrolizumab (Keytruda). Retrieved from <https://www.drugpatentwatch.com/patent/US-9115234>
3. Centers for Medicare and Medicaid Services. (n.d.). Medicare Coverage of Immunotherapy. Retrieved from <https://www.cms.gov/medicare/coverage/durable-medical-equipment-prosthetics-orthotics-and-other-nonphysician-services/immunotherapy>
4. Aetna. (n.d.). Keytruda. Retrieved from <https://www.aetna.com/care/conditions/cancer/keytruda.html>
5. Cigna. (n.d.). Keytruda. Retrieved from <https://www.cigna.com/individuals-families/health-plans/cancer-treatment/keytruda>
6. UnitedHealthcare. (n.d.). Keytruda. Retrieved from <https://www.unitedhealthcare.com/health-plans/cancer-treatment/keytruda>
7. Humana. (n.d.). Keytruda. Retrieved from <https://www.humana.com/health-plans/cancer-treatment/keytruda>

Note: The information provided in this article is for educational purposes only and should not be considered medical advice. Patients should consult with their healthcare provider to determine the best course of treatment for their specific condition.