Ovarian cancer and cancers of the Fallopian tubes are among the most common types of cancer women face as they get older. Fortunately, chemotherapy treatment for these types of cancer has proven to be incredibly beneficial for women battling the disease. Today, women of all ages who are affected by ovarian cancer are able to enjoy greater remission rates and longer durations of time spent cancer-free thanks to advances in modern medicine; however, one of the most difficult parts of tackling ovarian and other cancers is the potential for cancerous cells to repair themselves after being damaged by chemotherapy.
The mechanism through which this occurs utilizes proteins called poly (ADP-ribose) polymerases (PARPs). These proteins are part of the DNA process of healing and repair when cells are damaged, and because the body doesn’t know the difference between cells that have been intentionally destroyed and those that have been damaged due to accidental injury, PARP proteins work to repair cancer cells as well as non-cancerous cells. This process can then cause cancer to reappear after it has gone into remission or it can speed up cancer growth. This is why PARP inhibitors like Zejula are used in the treatment of cancers that have responded to certain types of chemotherapy.
What is Zejula?
Zejula (niraparib) is a prescription PARP inhibitor that is often prescribed to women who are recovering from ovarian cancer and who have responded to treatment utilizing platinum-based chemotherapy. The drug is used as a maintenance medication which denies DNA the chance to repair damaged cancer cells. One of the benefits to using Zejula is that it can be taken after a partial response to platinum-based chemotherapy as well as a complete response, allowing more women to potentially benefit from Zejula’s effects.
Does Medicare Cover Zejula?
In virtually all cases, Zejula is covered by Medicare Part D, the prescription drug benefit. To understand your Medicare coverage limitations, you will need to consult with your Part D plan’s formulary. Zejula is purchasable from retail pharmacies and is self-administered as a once-daily tablet, therefore, it falls within the guidelines of Part D.
It should be noted that because Zejula is meant to be prescribed only to women who have responded to platinum-based chemotherapy, you may need to work closely with your primary care physician and oncologist to ensure that your chemotherapy meets these requirements prior to receiving Zejula. This will assist you in avoiding potential setbacks in obtaining Medicare coverage for Zejula as your individual case needs will be documented.
Other Medicare Considerations
While Medicare coverage for Zejula may be covered by Part D, your situation at the time of administration of this medication may change how a claim is processed by Medicare. When formally admitted into a hospital or while being cared for in a skilled nursing facility, Medicare Part A would apply as this is the part of Medicare that covers treatment outside of a doctor’s office or at home. This may be your situation if you are being cared for after receiving chemotherapy if Zejula is provided during your stay. Upon being released from care, Medicare Part D would once again be the primary source of coverage for your retail pharmacy prescription of Zejula.
Medicare Advantage and Zejula
Medicare Advantage plan members may be able to receive Zejula if their MA plan includes prescription drug coverage. There may be differences in co-pays, premiums and deductibles from plan to plan. If you are enrolled in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many offer additional coverage.