Does Medicare Cover Tagrisso?

Writing by Last Updated On: May 3, 2023
Rakibul Hasan
Chief Editor of - Free Insurance Tips

Meet Rakibul Hasan, the visionary leader and founder of Freeinsurancetips. With over a decade of experience in the insurance sector, Rakibul is dedicated to empowering...Read more

Medicare is a government-funded health insurance program that provides coverage to people who are 65 years old or above, people with disabilities, and those with End-Stage Renal Disease (ESRD). It covers a wide range of medical services, including hospital stays, doctor visits, and prescription drugs. However, not all medications are covered under Medicare, and it can be confusing to determine what is and what isn’t covered.

One such medication is Tagrisso, which is a prescription drug used to treat non-small cell lung cancer. If you or a loved one has been diagnosed with lung cancer and are enrolled in Medicare, you may be wondering if Tagrisso is covered under your Medicare plan. In this article, we will explore the specifics of Medicare coverage for Tagrisso and what you need to know to ensure that you receive the best possible care.

Does Medicare Cover Tagrisso?
Yes, Medicare Part B and Part D may cover the cost of Tagrisso (osimertinib) if it is medically necessary and prescribed by a doctor. However, coverage may vary depending on the specific plan and location. It is recommended to check with your plan provider or Medicare representative to confirm coverage and any potential out-of-pocket costs.

Does Medicare Cover Tagrisso?

Does Medicare Cover Tagrisso?

If you or a loved one has been diagnosed with advanced non-small cell lung cancer (NSCLC), you may be considering treatment with Tagrisso. However, you may be concerned about the cost of this medication and whether it is covered by Medicare. In this article, we will explore whether Medicare covers Tagrisso and what you can expect if you are considering this treatment option.

What is Tagrisso?

Tagrisso (osimertinib) is a medication used to treat advanced NSCLC in patients who have a specific genetic mutation known as an epidermal growth factor receptor (EGFR) mutation. Tagrisso works by blocking the activity of this mutated protein, which helps to slow or stop the growth of cancer cells in the lungs.

Does Medicare Cover Tagrisso?

Yes, Medicare covers Tagrisso for eligible patients. However, the coverage and out-of-pocket costs may vary depending on your specific Medicare plan.

If you have Medicare Part B, Tagrisso may be covered as a part of your chemotherapy treatment. You will typically pay 20% of the Medicare-approved amount for the drug, and the Part B deductible will apply.

If you have a Medicare Advantage plan, the coverage and costs for Tagrisso may vary depending on the plan you have chosen. You will need to check with your plan provider to determine your specific costs and coverage details.

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What are the Benefits of Tagrisso?

The benefits of Tagrisso are significant for patients with advanced NSCLC and an EGFR mutation. Clinical studies have shown that Tagrisso can help to slow the progression of cancer and improve overall survival rates.

In a Phase III clinical trial, patients who received Tagrisso had a median progression-free survival of 18.9 months, compared to only 10.2 months for those who received chemotherapy. Additionally, patients who received Tagrisso had a significantly lower risk of disease progression or death.

What are the Side Effects of Tagrisso?

Like all medications, Tagrisso can cause side effects. The most common side effects include diarrhea, rash, dry skin, and nail problems. Some patients may also experience more serious side effects, such as lung problems or heart problems.

However, it is important to note that not all patients will experience these side effects, and many patients are able to tolerate Tagrisso well. Your healthcare provider can discuss the potential risks and benefits of Tagrisso with you and help you determine whether this medication is a good option for your specific situation.

Are There Alternatives to Tagrisso?

If you have advanced NSCLC with an EGFR mutation, there are other medications that may be used in addition to or instead of Tagrisso. These include medications such as Tarceva, Iressa, and Gilotrif. Your healthcare provider can help you determine which medication is the best option for your specific situation.

Tagrisso vs. Tarceva

Tagrisso and Tarceva are both medications used to treat advanced NSCLC with an EGFR mutation. However, there are some key differences between these two medications.

Tagrisso is a newer medication that has been shown to have significant benefits over Tarceva in clinical trials. In a Phase III clinical trial, patients who received Tagrisso had a significantly longer progression-free survival than those who received Tarceva.

Additionally, Tagrisso is taken as a once-daily pill, while Tarceva is taken as a daily pill. This may be a more convenient option for some patients.

Tagrisso vs. Iressa

Tagrisso and Iressa are both medications used to treat advanced NSCLC with an EGFR mutation. However, there are some key differences between these two medications.

Tagrisso is a newer medication that has been shown to have significant benefits over Iressa in clinical trials. In a Phase III clinical trial, patients who received Tagrisso had a significantly longer progression-free survival than those who received Iressa.

Additionally, Tagrisso is taken as a once-daily pill, while Iressa is taken as a daily pill. This may be a more convenient option for some patients.

Tagrisso vs. Gilotrif

Tagrisso and Gilotrif are both medications used to treat advanced NSCLC with an EGFR mutation. However, there are some key differences between these two medications.

Tagrisso is a newer medication that has been shown to have significant benefits over Gilotrif in clinical trials. In a Phase III clinical trial, patients who received Tagrisso had a significantly longer progression-free survival than those who received Gilotrif.

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Additionally, Tagrisso is taken as a once-daily pill, while Gilotrif is taken as a daily pill. This may be a more convenient option for some patients.

Conclusion

If you have been diagnosed with advanced NSCLC with an EGFR mutation, Tagrisso may be a treatment option worth considering. While Medicare does cover Tagrisso, your specific costs and coverage will depend on your Medicare plan. It is important to discuss the potential benefits and risks of Tagrisso with your healthcare provider to determine whether this medication is the right choice for you.

Frequently Asked Questions

Tagrisso is a medication used in the treatment of certain types of lung cancer. Medicare is a federal health insurance program in the United States for people who are 65 or older, as well as some younger individuals with disabilities or certain medical conditions. Here are some commonly asked questions about whether Medicare covers Tagrisso.

Does Original Medicare cover Tagrisso?

Original Medicare, which includes Part A and Part B, does cover Tagrisso if it is medically necessary and prescribed by a doctor. However, the medication may be subject to certain limitations, such as quantity limits, prior authorization requirements, and step therapy requirements. These restrictions are in place to ensure that the medication is used appropriately and cost-effectively.

If you have Original Medicare and are prescribed Tagrisso, you may need to pay a portion of the cost of the medication, such as a deductible or coinsurance. The amount you pay will depend on your specific Medicare plan and the cost of the medication.

Does Medicare Advantage cover Tagrisso?

Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies that contract with Medicare to provide benefits to beneficiaries. These plans must cover all the services that Original Medicare covers, but they may also offer additional benefits, such as prescription drug coverage.

If you have a Medicare Advantage plan that includes prescription drug coverage, it may cover Tagrisso if it is medically necessary and prescribed by a doctor. However, the medication may be subject to the plan’s formulary, which is a list of covered medications. If Tagrisso is not on the formulary, you may need to pay the full cost of the medication or work with your doctor to find an alternative medication that is covered by the plan.

Does Medicare cover Tagrisso for off-label uses?

Tagrisso is approved by the U.S. Food and Drug Administration (FDA) for the treatment of certain types of lung cancer. However, doctors may sometimes prescribe medications for uses that are not approved by the FDA, which is known as off-label use.

Medicare may cover Tagrisso for off-label uses if the medication is medically necessary and prescribed by a doctor. However, coverage for off-label uses may be subject to additional requirements, such as prior authorization, and may not be covered by all Medicare plans.

How can I find out if Tagrisso is covered by my Medicare plan?

To find out if Tagrisso is covered by your Medicare plan, you can contact your plan directly or check your plan’s formulary. The formulary is a list of covered medications and can be found on your plan’s website or by calling the plan’s customer service number.

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If you are prescribed Tagrisso and are unsure if it is covered by your plan, you can also ask your doctor or pharmacist for assistance. They may be able to work with your plan to determine coverage and help you find alternative medications if necessary.

What should I do if my Medicare plan does not cover Tagrisso?

If your Medicare plan does not cover Tagrisso, you may still be able to receive the medication through other means, such as through a patient assistance program or by working with your doctor to find an alternative medication that is covered by your plan.

You can also appeal the decision if you believe that the medication is medically necessary and should be covered by your plan. Your doctor or pharmacist can help you with the appeals process and provide guidance on the steps you need to take.

Does Medicare Cover Prescription Medications?

In conclusion, the answer to the question “Does Medicare Cover Tagrisso?” is not a simple yes or no. It ultimately depends on the specific circumstances of the patient and their diagnosis. While Medicare does cover some cancer treatments, including chemotherapy and radiation therapy, not all medications are covered under the program.

For patients with non-small cell lung cancer that has spread to other parts of the body and has a specific genetic mutation, Tagrisso may be covered by Medicare. However, patients must meet certain criteria and may need to go through a prior authorization process. It is important for patients to discuss their options with their healthcare provider and Medicare representative to determine the best course of action for their individual needs.

As a professional writer, it is important to emphasize the importance of understanding the complexities of healthcare coverage, especially when it comes to life-saving medications like Tagrisso. Patients and their loved ones should take the time to research and ask questions to ensure they receive the best care possible. While the process may be daunting, it is ultimately worth it to receive the treatment necessary to fight cancer and improve quality of life.

Rakibul HasanChief Editor of - Free Insurance Tips

Meet Rakibul Hasan, the visionary leader and founder of Freeinsurancetips. With over a decade of experience in the insurance sector, Rakibul is dedicated to empowering individuals to make well-informed decisions. Guided by his passion, he has assembled a team of seasoned insurance professionals committed to simplifying the intricate world of insurance for you.

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