Does Medicare Cover Neulasta? 

Cancer remains one of the most difficult challenges for modern medicine and the hundreds of thousands of Americans who face the disease. Currently, therapies are in development that show a lot of promise in treating cancer, and traditional treatments like chemotherapy continue to be useful in helping cancer patients improve quality-of-life factors.

Unfortunately, as effective as chemotherapy can be in treating cancer, it can come with its own side effects and health risks. Among these risks is the potential for developing severe infections. Because chemotherapy kills off healthy cells while stopping cancer cells, some people being treated with chemotherapy develop a weakened immune system. When this happens, slight infections that may not be a cause for concern in the general population become a much bigger deal for people receiving chemotherapy.

How are these risks mitigated?

One way to mitigate the risk of infection while undergoing chemotherapy is to take extra precautions and avoid situations where infectious diseases or bacteria could be present. This may require seniors undergoing chemotherapy to take additional steps to protect their health. Regular monitoring by your healthcare provider is advised if you are receiving chemotherapy. Seniors and retirees concerned about the risk of infection during chemotherapy may also benefit from using medications like Neulasta.

Neulasta (pegfilgrastim) is a medication that stimulates white blood cell production in bone marrow. This can help your body to react appropriately to infections and reduce the risk of serious complications. Neulasta is administered via a wearable on-body injection system. This system attaches to your arm and can be worn during everyday activities. The medication is automatically injected into your body from the on-body injector, and Neulasta lasts for around one-to-two weeks.

Does Medicare cover Neulasta?

If you’re eligible for Medicare and are taking part in chemotherapy and are prescribed Neulasta, you may wonder whether your Medicare benefits cover the medication. Medicare Part D is the prescription drug coverage portion of Medicare. This optional coverage helps pay for prescription drugs found in your plan’s formulary. For a medication to be covered by Medicare benefits under Part D, the drug must be available for purchase from a pharmacy for use at home.

Neulasta is not covered by Medicare Part D because the injector must be applied by a healthcare provider in a clinical setting. The good news is that Medicare Part B may apply toward the cost instead. Medicare Part B provides outpatient coverage for doctor visits, surgery, durable medical equipment, lab testing and more.

Many Medicare insurance plans cover Neulasta, but you are encouraged to inquire with your plan manager to determine if your Part B benefits offer this coverage. If your plan does not cover Neulasta, you can file for a waiver with the help of your doctor. If your Part B Medicare benefits do cover Neulasta, you will pay 20% of the cost, while Medicare insurance covers 80%.

Medicare Advantage and Medigap coverage of Neulasta

According to Amgen, makers of Neulasta, many Medicare recipients who have either Medicare supplement insurance (Medigap) or a Medicare Advantage plan may be able to receive coverage for Neulasta at a discounted rate. Medigap coverage is designed to fill in the gaps that Original Medicare benefits do not cover.

Medicare Advantage plans often have additional benefits beyond the Part A and Part B benefits of Original Medicare. It’s important to note that while you may be able to obtain a discount on Neulasta with Medigap coverage or a Medicare Advantage plan, you cannot carry both types of added coverage simultaneously.