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Does Medicare Cover Nexavar?

Unrecognizable doctor holding highlighted handrawn Kidneys in hands. Medical illustration, template, science mockup. stock photo
By Daniel Petkevich
Nov 30, 2022

You've probably got coverage depending on your Plan D

Knowing that you have coverage can offer peace of mind amidst very challenging times for Medicare beneficiaries seeking treatment for liver cancer. Luckily, over 98% of Medicare Part D plans will provide coverage for Nexavar. Read more to learn about Medicare coverage and potential restrictions on coverage.

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What is Nexavar?

Nexavar is a prescription medication used to treat advanced stages of kidney and liver cancer. The active ingredient in Nexavar, sorafenib, blocks signals that tumors use to spread and grow. The medicine works by targeting proteins in the cancer cells.

How do Medicare Part D plans cover Nexavar?

Most Medicare Part D plans offer coverage for Nexavar. Coverage may vary by plan, so it’s important to contact your insurance provider directly to learn more about how your specific plan covers Nexavar. Check your Part D plan formulary to make sure Nexavar is listed there and for tier information. Nexavar is typically on Tier 5, making it among the more expensive drugs.

What restrictions may apply to coverage?

Your Part D plan may impose a variety of restrictions on Nexavar. These could include limits on the number of refills and prior authorization. Part D plans usually require prior authorization or a step therapy protocol before covering Nexavar. This means that your doctor will need to provide evidence that other treatments have failed before Medicare will approve coverage for Nexavar.

How can beneficiaries find out if their plan covers Nexavar?

The best way to find out if your plan covers Nexavar is to contact your Part D provider directly and ask. You can also look up your formulary online or call the customer service number on the back of your insurance card. It’s wise to discuss any potential restrictions that may apply before beginning treatment with Nexavar. Your doctor or pharmacist can also help to clarify if there are any restrictions on your coverage.

How can people get more information about Medicare Part D plans and liver cancer treatments?

People can visit Medicare’s website for more information about Part D plans and coverage. If you have any questions about your Part D plan or Nexavar, you can contact the customer service number on the back of your insurance card. You can also speak to your doctor or pharmacist for more information about liver cancer treatments.

Takeaway

For Medicare beneficiaries seeking treatment for liver cancer, Nexavar is usually covered by Part D plans. Coverage may vary by plan and could include restrictions such as limits on the number of refills or prior authorization. It’s important to check with your doctor before you decide to start or stop taking any medication (including Nexavar). This content is for informational purposes only.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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