When you think about cancer, the treatments that most likely come to mind are chemotherapy and radiation therapies. However, there are other non-invasive treatment options for cancer patients as well, including the use of prescription medications. Keytruda is a medication that helps interfere with and slow the progression of cancer. Sadly, for most individuals, Medicare benefits will not cover the costs of this medication. However, if you do require cancer treatments, other medications may be available for you that are covered by Medicare.
What is Keytruda?
Keytruda is also known as the generic pembrolizumab. This medication works as an immunotherapy drug. This means that it boosts your immune system to help it better fight off harmful cells, including cancerous ones.
When cancer occurs in the body, the cells have special mechanisms that help them evade destruction so they can multiply and spread throughout the body. This is why it is so important to treat cancer early on before it has the chance to grow extensively.
The immune system has lots of different cells that serve specific functions in fighting off diseases and infections. T cells are some of the most important cells, and there are four main types of them in the body. Memory T cells store information about diseases so that the body can recognize the infection quickly and fight it off if the body is exposed to it again. Memory cells can then change into natural killer T cells, CD4+ helper T cells, and CD8+ cytotoxic T cells.
Natural killer, CD4+, and CD8+ T cells all travel throughout the body and have binding sites specific to a certain disease. When these cells find the cells associated with that disease, they can divide rapidly, boost the immune response, and destroy the cells before they can multiply. This is the body’s primary defense mechanism for destroying cancer cells.
One of the ways that cancer can evade destruction from the immune system is using the PD-1 pathway, which allows them to hide from T cells. The PD-1 protein is found on the body’s T cells. On some of your body’s healthy cells is a protein called PD-L1, which tells the T cell not to attack. Some cancer cells have this protein as well. If a cancer cell has the PD-L1 protein, the T cell will not attack it, allowing it to multiply and grow to produce more and more cancer cells.
Keytruda works to block this pathway, which prevents the cancer cells from being able to communicate with the T cells. This allows the T cells to attack the cancer cells as they normally would and prevent them from spreading further. Keytruda is most often used to fight cancers of the skin, lungs, esophagus, kidney, liver, stomach, cervix, and bladder. It is used to treat various lymphomas as well.
Do Medicare Benefits Cover Keytruda?
In most cases, Medicare plans do not cover the costs of Keytruda. This medication is quite expensive, making the out-of-pocket costs quite high. However, there are a number of other cancer-fighting medications and treatments available that are covered by Medicare.
If you have Original Medicare, any care or treatment you receive during a hospital stay will be covered by Medicare Part A. You will be required for paying up to your deductible and for any premium payments. If your treatments take place in an outpatient clinic, Medicare Part B will usually cover 80 percent of the treatment costs. You will likely have to pay the other 20 percent once your deductible has been reached. If you have enrolled in a Medigap plan, you may have help paying your deductibles, coinsurance, or copayments.
If you are primarily using medications to fight cancer, you will require a Medicare Part D prescription drug plan or Medicare Advantage plan that includes drug coverage. Each plan will have its own formulary and tiers of pricing. These plans often require a copayment for each medication, but they significantly reduce the out-of-pocket costs associated with cancer medications.