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Is Keytruda covered by Medicare / Medicaid?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Jan 2, 2021.

Official Answer

by Drugs.com

Key Points

  • Keytruda is usually covered by Medicare or Medicaid, but your costs can vary greatly.
  • What you pay for Keytruda will depend on your insurance plan, if you have a deductible or coinsurance, or your state’s coverage for Keytruda.
  • Speak with your insurance carrier to determine if Keytruda is covered under your insurance plan, and what the alternatives are if it is not covered. Be sure to speak with your doctor about medications costs before treatment.

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 Merck, the manufacturer, if you meet certain income criteria.

  • Your eligibility may be based on your insurance coverage, household income, and projected out-of-pocket medical expenses.
  • Contact The Merck Access Program at 855-257-3932 (or 855-257-7332 for the hearing impaired)
  • Other groups, such as nonprofit organizations, may be able to provide financial support for your medications. Talk to your healthcare provider about other ways to afford your medication.

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.

Learn more: Health Insurance 101: Become An Expert to Save Healthcare Dollars

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.

References
  • Keytruda.com. Merck & Co. Accessed Jan. 3, 2021 at https://www.keytruda.com/financial-support/
  • Bunis D. Understanding Medicare’s Options: Parts A, B, C and D. AARP. Accessed Jan. 2, 2021 at https://www.aarp.org/health/medicare-insurance/info-01-2011/understanding_medicare_the_plans.html
  • The Marck Access Program. Keytruda. Accessed Jan. 4, 2021 at https://www.merckaccessprogram-keytruda.com/hcp/the-merck-copay-assistance-program/

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