See the DrugPatentWatch profile for xofigo
Does Medicare cover Xofigo (radium Ra 223 dichloride)?
Medicare generally covers medically necessary cancer treatments when they’re provided by a Medicare-enrolled provider and billed under an appropriate benefit category (such as Part B or Part D, depending on how the drug is administered and billed). However, coverage can still depend on the setting (outpatient vs. inpatient), the provider’s billing, and your specific Medicare plan.
Is Xofigo covered under Medicare Part B or Part D?
Xofigo is typically administered by clinicians (as an injection/radiopharmaceutical in a treatment setting), which often places coverage discussions under Medicare Part B rather than Part D. Whether your claim is handled under Part B (often for physician-administered drugs in outpatient settings) or Part D (for prescription drug benefit claims) depends on how it is delivered and billed for your case.
What determines whether it’s paid by Medicare?
Coverage is usually based on whether the use is considered medically necessary and appropriate for Medicare’s rules and the drug’s labeled uses. Medicare may also require documentation of diagnosis and treatment plan, and payments can vary based on your:
- Medicare Part (B vs. D)
- Location of care (outpatient clinic vs. hospital outpatient department)
- Whether your provider is enrolled and accepts Medicare
- Whether the drug is covered for your specific indication per applicable rules
What will patients typically pay (copays/coinsurance)?
Even when Medicare covers a drug, you can still owe costs such as Part B coinsurance or deductibles, depending on your plan and whether you have supplemental coverage (Medigap) or Medicare Advantage.
How to confirm your exact coverage quickly
The fastest way to confirm is to ask your oncology team or the billing department:
- Which Medicare benefit they plan to bill (Part B vs Part D) for Xofigo in your setting
- Whether they expect to treat under an approved/covered indication
- An estimate of your out-of-pocket cost based on your plan
If you tell me whether you have Original Medicare or a Medicare Advantage plan (and whether Xofigo will be given in an outpatient clinic or hospital), I can help you narrow down which part usually applies and what to ask for.