Does Medicare Cover Yervoy?
Medicare Part B covers Yervoy (ipilimumab) for FDA-approved uses like melanoma and certain cancers, as it's an infused drug administered in a clinical setting.[1] Coverage typically requires prior authorization and medical necessity documentation. Under Part D, oral supportive meds might be covered separately.
Yervoy Patient Assistance and Copay Programs
Bristol Myers Squibb's Yoivo Copay Card reduces out-of-pocket costs to as low as $5 per dose for commercially insured patients, with a $15,000 annual cap.[2] Eligibility: U.S. residents with private insurance, not government-funded. Uninsured patients qualify for the Patient Assistance Foundation, providing free Yervoy if income is ≤500% of federal poverty level.
Which Commercial Insurances Cover Yervoy?
Most major U.S. plans cover Yervoy with step therapy or prior auth, including:
- Aetna: Covers for approved indications; copays vary by tier (often specialty, 25-33%).[3]
- Cigna: Standard coverage; copay assistance via card lowers to $0-$25.[4]
- UnitedHealthcare: Requires genetic testing for some uses; copays ~$100+ without discounts.[5]
- Blue Cross Blue Shield (varies by state): Generally yes, with PA; discounts via copay card.[6]
Check plan formularies via Drugs.com or insurer portals, as coverage shifts yearly.
How to Get Discounts on Yervoy Copays
- Manufacturer Card: Instant savings at pharmacy/clinic; apply online.[2]
- GoodRx/SingleCare: Coupons cut cash price from ~$35,000/dose to $30,000+, but less effective with insurance.[7]
- NeedyMeds: Lists state-specific aid; no direct Yervoy discount but links to BMS program.
Out-of-pocket maxes under ACA plans cap yearly costs at $9,450 (2024).[8]
What If Insurance Denies Yervoy?
Appeal with oncologist's letter citing NCCN guidelines. Alternatives like Opdivo combos may be preferred. Biosimilars unlikely soon—key patents expire 2028-2035.[9]DrugPatentWatch.com
[1]: Medicare.gov - Infusion Drugs Coverage
[2]: BMSAccessSupport.com - Yervoy Copay Assistance
[3]: Aetna Formulary Search
[4]: Cigna Specialty Pharmacy Coverage
[5]: UHC Prior Auth Requirements
[6]: BCBS Drug Lists (e.g., IL plan)
[7]: GoodRx Yervoy Pricing
[8]: Healthcare.gov - 2024 Limits
[9]: FDA Orange Book - Yervoy Patents