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does Medicare cover Rituxan

Does Medicare Cover Rituxan?

Cancer is still an all too common and all too lethal disease in this day and age.  

If there is some comfort here, it’s that scientists have been making some amazing breakthroughs in cancer treatments. Treatments that can extend the lives of those with cancer if not knock the cancer out of the body completely.  

One of these treatments that is cause for hope is the drug Rituxan. Rituxan, also known by its generic name, Rituximab, is a drug that can also go with chemotherapy to help battle certain types of cancer. It is also used to treat other conditions such as rheumatoid arthritis. 

However, Rituxan (Rituximab) is quite expensive. Not everyone who needs it may be able to afford it, so a common question many people have is, “Does Medicare cover Rituxan?”  

In this article, we answer that question in clear, plain English. You will also find the average costs of Rituxan (Rituximab) and other helpful info. 

Does Medicare Cover Rituxan? 

The short answer is yes; Medicare will cover the cost of Rituxan (Rituximab). But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Rituxan (Rituximab). Below we look at what these are so you know what to expect. 

Original Medicare (Medicare Part A and Part B) provides coverage for Rituxan (Rituximab) costs. Coverage for Rituxan falls under Medicare Part B.  

However for Medicare Part B to cover your Rituxan, your healthcare provider has to decide that it is medically necessary in order to treat your cancer or other condition. And he/she has to give you a prescription for the drug.  

Once approved, Medicare Part B will cover 80% of the cost, and you will pay for the remaining 20%.  

Medicare Advantage plans (Medicare Part C) also provide coverage for Rituxan (Rituximab). They cover everything Original Medicare covers as well as some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan. 

You can also compare Medicare Part D plans available where you live and see what coverage they may offer for the drug.  

How Much Does Rituxan (Rituximab) Cost? 

A 10 milliliter Rituxan (Rituximab) costs around $100 per unit. A supply of 10 milliliters of Rituxan (Rituximab) cost over $990.  

A single unit of 50 milliliters Rituxan (Rituximab) costs $98.28 A supply of 50 milliliters of Rituxan (Rituximab) costs $4,913.79.  

A single unit of 100 (10 x 10 milliliters) Rituxan (Rituximab) costs $98.18. A supply of 100 (10 x 10 milliliters) Rituxan (Rituximab) costs $9,818.09.  

The Basics on Rituxan 

Rituxan (Rituximab) is a type of antibody medication that can be used with or without chemotherapy. It attacks cancer cells where cancer starts.  

Rituxan (Rituximab) attaches itself to the CD20 protein, which can be found on the surface of blood cells that have cancer as well as some healthy blood cells. Once it attaches to the blood cell, it can either destroy the cancer cells or strengthen the immune system to help against cancer.  

Some of the conditions that it can treat are non-Hodgkin’s lymphoma, leukemia, rheumatoid arthritis, pemphigus vulgaris and granulomatosis with polyangiitis.  

There are some serious side effects with this drug so be sure you discuss these with your physician before starting Rituxan.  

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover psychological therapy?

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