Are drugs such as Nubeqa covered under Medicare Part B, or is there a big out-of-pocket cost because it's a specialty drug? Just trying to get a handle on my treatment costs. My understanding is that if it's administered in the hospital or outpatient (such as Lupron shot or docetaxel infusion for example) then it's covered by Part B. Otherwise, it's not. My preliminary estimate of Nubeqa (600 mg 2/xday) is about $11,000/year. I'm wondering if they have a special list of anti-cancer drugs that's covered... Thanks!

In general, if a drug is injected or administered via an IV at a doctor's office or cancer center it is covered under Part B of Original Medicare. If you purchase the drug via a pharmacy and administer it yourself it is covered under Part D of Original Medicare. Whether a specific drug is covered under Part D depends on the insurance company you choose for Part D. Some insurance companies may cover Nubeqa and others may not. And among those that cover Nubeqa there may be a huge price difference. But you are in luck because this is the open enrollment period when you can switch Part D insurance companies. Also, I have found that the social workers at my cancer center are very good at finding the best price for a given drug.

Medicare has some key restrictions when it comes to drugs thus manufacturers have to work directly with patients, not insurance or PBM's. My wife gets her cancer drug directly from Pfizer. She calls them monthly to order the next month's batch. We are getting to that time soon when the annual reapplication will be required.

I am still interested in how you can get it for $50 copay per their website. Hope you get to the bottom of it.