Does Medicare Cover Thyrogen Injections?

Thyroid cancer, like other forms of cancer, needs to be treated in its early stage to lessen its lethality rate. And one of the ways to treat thyroid cancer is through the medication known as Thyrogen.

If you or a loved one has thyroid cancer, you may be wondering “does Medicare cover Thyrogen injections?” In this article, we answer that question in clear, plain English. You will also find the average costs of Thyrogen injections and other helpful info.

Does Medicare Cover Thyrogen Injections?

The short answer is yes; Medicare will cover the cost of a Thyrogen injection. 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 Thyrogen injections. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for Thyrogen injections. Part B provides coverage for your Thyrogen injections if it is considered medically necessary. Coverage for Thyrogen injections is provided by Medicare Part B if it will be administered in an outpatient setting such as a doctor’s office.

You will first need to purchase the Thyrogen injections, then have your healthcare provider administer the medication to you. After your healthcare provider administers the medication to you, you can bill Medicare Part B for reimbursement.

If approved, Medicare Part B will cover 80 percent of the costs of your Thyrogen injections. You will pay for the remaining 20 percent as coinsurance.

Part C and Part D Coverage for Thyrogen Injections

Medicare Advantage plans (Medicare Part C) also provide coverage for Thyrogen injections. By law, they must cover everything Original Medicare covers. But these plans offer additional benefits too. Exactly what the benefits are and how much the plans cost varies depending on the specifics of your plan.

Medicare Part D plans do not provide coverage for Thyrogen injections. Even though these injections are a type of medication, Medicare Part D does not provide coverage for them. Medicare Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Do Thyrogen Injections Cost?

The average cost of Thyrogen injections is $4,800. Your total cost will include the price to purchase the Thyrogen as well as the fee to administer it.

What Are Thyrogen Injections?

Thyrogen injections are a man-made protein medication. It’s primary use is to diagnose and treat thyroid cancer. This medication is a form of human thyroid-stimulating hormone or also known as TSH.

It can be used with or without radioactive iodine imaging. With radioactive iodine, Thyrogen injections can remove infected thyroid tissue in patients with thyroid cancer who have had most or all of their thyroid glands removed.

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.