Keytruda® Medicare Coverage

Keytruda is an immunotherapy used to treat several types of cancers. It works by stimulating the immune system to attack cancer cells.

Keytruda is administered intravenously at a doctor’s office or infusion center over 30 minutes usually every 3 weeks. Because this medication works on the immune system, it can attack normal organs and tissues in the body during treatment or even after treatment ends, which can be severe or life-threatening.

Common side effects of this medication include fatigue, pain, diarrhea, constipation, decreased appetite, nausea and rash.

How much does Keytruda cost with Medicare?

If Medicare Part B covers Keytruda treatments for you because you meet the qualifying conditions, you’ll typically pay 0% to 20% of the Medicare-approved amount for the Keytruda prescription price, after you meet your Part B deductible.

In 2024, the Medicare Part B deductible is $240 per year. Once you pay this amount, you’ll pay the remaining copay costs Medicare Part B doesn’t cover.

Does Medicare cover Keytruda?

Medicare Part B covers injectable and infused drugs administered by a medical provider for qualified beneficiaries.

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Keytruda coverage.¹

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Keytruda, your Part B benefits will cover Keytruda.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Part D plans or Medicare Advantage plans that cover drugs include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2024 Medicare Advantage plans include prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover prescription drugs. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Additional information

Keytruda is indicated to treat several types of advanced cancers and is not a chemotherapy drug, but an immunotherapy drug.

This immunotherapy agent has been shown to significantly shrink tumors, reduce disease progression and even help patients extend their life.

Keytruda has been labeled as breakthrough therapy in certain advanced cancers and has received accelerated approval by the FDA in certain cancers because of the significant benefit of this medication seen in clinical trials.

Keytruda should be used with caution in patients with immune problems, organ transplant, stem cell transplant, liver or lung problems.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.