Does Medicare Cover Yervoy?
Yes, Medicare covers Yervoy (ipilimumab), a Bristol Myers Squibb immunotherapy drug used for melanoma and other cancers, primarily under Medicare Part B as an outpatient drug administered by a doctor.[1] Coverage requires medical necessity, confirmed by a physician's documentation.
Which Medicare Parts Cover It?
- Part B: Covers Yervoy infusions in clinics or hospitals at 80% of the Medicare-approved amount after the Part B deductible ($240 in 2024). Patients pay 20% coinsurance, which can total thousands per treatment cycle due to high list prices (around $155,000 for a full melanoma course).[2][1]
- Part D: Does not typically cover infused drugs like Yervoy; it focuses on self-administered prescriptions.[1]
- Part A: May cover it during inpatient hospital stays if needed.
No coverage under Medicare Advantage (Part C) varies by plan, but most follow Part B rules.
What Affects Coverage and Costs?
Prior authorization is often required to confirm FDA-approved uses (e.g., advanced melanoma, renal cell carcinoma with nivolumab).[3]
Out-of-pocket costs average $30,000+ per year before assistance, though Yervoy has no patient assistance cap for eligible Medicare enrollees via Bristol Myers' program.[4]
Medigap (supplemental) policies can reduce the 20% coinsurance.
How Does Coverage Compare to Similar Cancer Drugs?
| Drug | Medicare Part | Typical Coverage Notes |
|------|---------------|-----------------------|
| Yervoy (ipilimumab) | Part B | Infusion only; high coinsurance |
| Opdivo (nivolumab, often combined with Yervoy) | Part B | Same as Yervoy[3] |
| Keytruda (pembrolizumab) | Part B | Similar; broader indications[1] |
| Oral targeted therapies (e.g., Zelboraf) | Part D | Lower infusion costs but different copays |
When Might Medicare Deny Coverage?
Denials occur for off-label use without strong evidence, experimental settings, or lack of prior auth. Appeals succeed in about 80% of cancer drug cases via Medicare processes.[5] Patients over 65 or with ESRD qualify automatically if eligible.
[1]: Medicare.gov - Drugs Covered by Medicare Part B
[2]: CMS - Medicare Coverage Database
[3]: FDA - Yervoy Label
[4]: Bristol Myers Squibb Patient Assistance
[5]: KFF - Medicare Drug Denials