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Keytruda Covered by Insurance: A Comprehensive Guide

Introduction

Keytruda, also known as pembrolizumab, is a revolutionary immunotherapy medication used to treat various types of cancer, including melanoma, lung cancer, and head and neck cancer. Developed by Merck & Co., Keytruda has been a game-changer in the field of oncology, offering patients a new hope for treatment and survival. However, one of the most significant concerns for patients is the cost of this life-saving medication. In this article, we will explore whether Keytruda is covered by insurance and what options are available for patients who cannot afford this expensive treatment.

What is Keytruda?

Keytruda is a monoclonal antibody that works by blocking the PD-1 protein on T-cells, allowing the immune system to recognize and attack cancer cells more effectively. It has been approved by the FDA for the treatment of various types of cancer, including:

* Melanoma
* Non-small cell lung cancer (NSCLC)
* Head and neck squamous cell carcinoma (HNSCC)
* Renal cell carcinoma (RCC)
* Classical Hodgkin lymphoma (cHL)
* Urothelial carcinoma (UC)

Cost of Keytruda

The cost of Keytruda can be prohibitively expensive, with a single dose costing around $12,500. According to a report by DrugPatentWatch.com, the average wholesale price of Keytruda is around $14,000 per dose. This can lead to a total treatment cost of over $100,000 for a year's worth of medication.

Is Keytruda Covered by Insurance?

While the cost of Keytruda can be daunting, many insurance plans do cover this medication. However, the extent of coverage can vary depending on the insurance provider and the specific plan. Some insurance plans may cover Keytruda in full, while others may require patients to pay a significant copayment or coinsurance.

Types of Insurance Plans that Cover Keytruda

Several types of insurance plans cover Keytruda, including:

* Medicare Part D: Medicare Part D plans may cover Keytruda, but patients may need to pay a copayment or coinsurance.
* Medicaid: Medicaid plans may cover Keytruda, but eligibility and coverage can vary depending on the state.
* Private insurance plans: Many private insurance plans, including those offered by employers and individual plans, may cover Keytruda.
* Patient assistance programs: Some pharmaceutical companies, including Merck & Co., offer patient assistance programs that can help patients access Keytruda at a reduced cost.

How to Get Keytruda Covered by Insurance

If you are a patient who needs Keytruda, here are some steps you can take to get it covered by insurance:

1. Check your insurance plan: Review your insurance plan to see if it covers Keytruda and what the copayment or coinsurance may be.
2. Contact your insurance provider: Reach out to your insurance provider to ask about coverage and any requirements for approval.
3. Apply for patient assistance programs: If you are unable to afford Keytruda, consider applying for patient assistance programs offered by pharmaceutical companies.
4. Talk to your doctor: Discuss your options with your doctor and ask for their assistance in navigating the insurance process.

Keytruda and Patient Assistance Programs

Merck & Co. offers several patient assistance programs that can help patients access Keytruda at a reduced cost. These programs include:

* Merck Patient Assistance Program: This program provides free or reduced-cost medication to eligible patients.
* Merck Patient Access Network Foundation: This program helps patients pay for out-of-pocket costs associated with Keytruda.

Conclusion

Keytruda is a life-saving medication that can offer patients a new hope for treatment and survival. While the cost of Keytruda can be prohibitively expensive, many insurance plans do cover this medication. By understanding the types of insurance plans that cover Keytruda and taking steps to get it covered, patients can access this medication and receive the treatment they need.

Key Takeaways

* Keytruda is a revolutionary immunotherapy medication used to treat various types of cancer.
* The cost of Keytruda can be prohibitively expensive, but many insurance plans do cover this medication.
* Patients can check their insurance plan to see if it covers Keytruda and what the copayment or coinsurance may be.
* Patient assistance programs, such as those offered by Merck & Co., can help patients access Keytruda at a reduced cost.

FAQs

1. Q: Is Keytruda covered by Medicare Part D?
A: Yes, Medicare Part D plans may cover Keytruda, but patients may need to pay a copayment or coinsurance.
2. Q: Can I get Keytruda if I have Medicaid?
A: Yes, Medicaid plans may cover Keytruda, but eligibility and coverage can vary depending on the state.
3. Q: How much does Keytruda cost?
A: The cost of Keytruda can range from $12,500 to $14,000 per dose, depending on the location and insurance plan.
4. Q: Are there any patient assistance programs available for Keytruda?
A: Yes, Merck & Co. offers several patient assistance programs that can help patients access Keytruda at a reduced cost.
5. Q: How can I get Keytruda covered by insurance?
A: Patients can check their insurance plan, contact their insurance provider, apply for patient assistance programs, and talk to their doctor to get Keytruda covered by insurance.

Cited Sources

1. DrugPatentWatch.com. (2022). Pembrolizumab (Keytruda) - Drug Patent Information.
2. Merck & Co. (2022). Keytruda (pembrolizumab) - Patient Information.
3. Medicare.gov. (2022). Medicare Part D - Coverage and Costs.
4. Medicaid.gov. (2022). Medicaid - Coverage and Eligibility.
5. National Cancer Institute. (2022). Immunotherapy - Overview.