Is it covered by Medicare / Medicaid?
Key Points
How much does Keytruda cost with Medicare?
Medicare is a national medical insurance plan for people 65 years and older in the U.S. Medicare Advantage plans (Part C) include hospital coverage through Medicare Part A, medical insurance through Part B, and prescription drug coverage through Part D.
Patients with Medicare may or may not have to pay a portion of the cost of Keytruda (generic name: pembrolizumab) based on their insurance plan. For example, with a Medicare Advantage plan, 41% of patients had no out-of-pocket costs for the 200 mg dose of Keytruda. Roughly 80% of patients who were responsible for a portion of the cost paid between $0 and $925 per infusion, after meeting their deductible.
Supplemental beneficiary coverage through an employer or a MediGap plan (a supplemental plan for traditional Medicare) may help cover Medicare Part B coinsurance or co-payments.
For those patients with only traditional Medicare and no supplemental drug coverage (Part D), 80% of people paid between $1,000 and $1,950 per infusion, after meeting their deductible.
Does Medicaid cover Keytruda?
Medicaid is a U.S. government-run health insurance program that provides medical assistance for low-income individuals and families. It is jointly run by the federal government and individual US states. State Medicaid programs may provide coverage for Keytruda (pembrolizumab) but it can vary based on your state.
Most patients with Medicaid typically pay $4 to $8 per Keytruda infusion. Your costs may be higher based on your income, even if you have Medicaid. Your health plan and costs are determined by your state.
To learn more about Medicaid in your state visit Medicaid.gov
Can I get Keytruda if I don’t have insurance?
If you do not have insurance or are unemployed, you may be eligible to receive Keytruda at no cost from the manufacturer Merck if you meet certain income criteria.
Merck Copay Assistance Program
The Merck Copay assistance program is not valid for patients with government insurance such as Medicare or Medicaid or uninsured patients. It is eligible for those with private, commercial insurance, for example, through an employer or the Marketplace on Healthcare.gov.
Once enrolled, eligible, privately insured patients pay the first $25 of their co-pay per infusion. Maximum co-pay assistance program benefit is $25,000 per patient, per calendar year. Call 1-855-257-3832 and ask your doctor for more information
This is not all the information you need to know about Keytruda (pembrolizumab) for safe and effective use. Review the full Keytruda information here, and discuss this and any questions you have with your doctor or other health care provider.
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Disclaimer
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