Keytruda (pembrolizumab) is the world's best-selling cancer drug, used across dozens of cancer types. Insurance coverage for Keytruda is generally robust for FDA-approved indications, as cancer drugs fall under medical benefit (Part B for Medicare) when administered in a clinical setting. Out-of-pocket costs depend on whether coverage is under medical or pharmacy benefit.

Key Facts

Keytruda is typically covered under the medical benefit (not pharmacy) since it is administered by IV infusion
Medicare Part B covers Keytruda at 80% after the deductible for approved indications
Most commercial plans cover Keytruda with prior authorization and documentation of cancer type and biomarker testing
Without insurance, Keytruda costs approximately $10,000 to $12,000 per infusion (every 3 to 6 weeks)
Merck's Keytruda patient assistance program provides the drug at no cost for eligible uninsured patients
Keytruda is approved for 30+ cancer types, making it one of the most broadly indicated cancer drugs

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Frequently Asked Questions

Is Keytruda covered under medical or pharmacy benefits?

Keytruda is usually covered under your medical benefit (not pharmacy) because it is administered by IV infusion in a clinical setting. This means it falls under Part B for Medicare patients, with 80% coverage after the deductible. For commercial plans, it is typically processed through the medical benefit with applicable coinsurance.

How much does Keytruda cost with insurance?

Under medical benefit coverage, you typically pay 20% coinsurance after your deductible. For Medicare Part B, this means approximately $2,000 to $2,400 per infusion without supplemental coverage. Medigap plans or employer supplemental coverage can reduce this further. Out-of-pocket maximums on commercial plans also limit total exposure.

Does Keytruda have a copay assistance program?

Merck offers the Keytruda patient assistance program for uninsured or underinsured patients who meet income criteria. For commercially insured patients, Merck's copay assistance can help reduce out-of-pocket costs. Medicare patients cannot use manufacturer copay cards but may qualify for other financial assistance programs.

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