Pembrolizumab
Specialty Drug

Keytruda

PEMBROLIZUMAB is a monoclonal antibody. It is used to treat melanoma, head and neck cancer, Hodgkin lymphoma, lymphoma, non-small cell lung cancer, cervical cancer, urothelial cancer, stomach cancer, and cancers that have a certain genetic condition. Compare PD inhibitors.

Pembrolizumab Medicare Coverage

Overview

Does Medicare cover Keytruda?

Yes.
98% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Keytruda co-pay with Medicare?

It depends. Which coverage stage are you in? Click on a tab below…

Deductible
Typical
Donut Hole
Post-Donut Hole
Co-Pay Range
$620 – $7557
In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.
Co-Pay Range
$537 – $7557
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$967 – $7557
In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year.
Co-Pay Range
$107 – $7557
In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare will cover most of your drug costs. In 2016, this stage begins once you have spent $4,850.
Want an exact price for your co-pay?

Ways to Save on Pembrolizumab

Here are some ways that may lower the cost of your Keytruda prescription.

Patient Assistance Program
Receive your prescription at no charge if you are eligible.
Patient Assistance Program
Save at least $5 per month on your prescription.

Find Your Pembrolizumab Medicare Co-Pay

Here are average co-pays for some of the most popular Medicare plans. Be sure to add your plan to see your specific co-pay. If a price is shown in red, GoodRx has found discount prices that are lower than your Medicare co-pay.

Average Co-Pay for 3 vials of Keytruda 50mg

Medicare Plan Name Average Co-Pay
AARP MedicareRx Preferred (PDP) $926
AARP MedicareRx Saver Plus (PDP) $583
AARP MedicareRx Walgreens (PDP) $571
Aetna Medicare Rx Saver (PDP) $619
Anthem Blue Cross MedicareRx Plus (PDP) $716
Anthem MediBlue Essential (HMO) $692
Cigna-HealthSpring Preferred (HMO) $666
EnvisionRxPlus (PDP) $575
Express Scripts Medicare - Choice (PDP) $579
Express Scripts Medicare - Value (PDP) $557
First Health Part D Value Plus (PDP) $774
Humana Enhanced (PDP)Lower price available $7557
Humana Preferred Rx Plan (PDP)Lower price available $7557
Humana Walmart Rx Plan (PDP)Lower price available $7557
Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost) $620
MedicareBlue Rx Standard (PDP) $597
SilverScript Plus (PDP) $781
Symphonix Value Rx (PDP) $583
TexanPlus Classic (HMO) $1998
WellCare Classic (PDP) $605
Don't see your Medicare plan above?

Find and configure your plan to see exact co-pay prices for your meds.

Pembrolizumab Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Keytruda that may include:

Prior Authorization

Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan and they may require you to have your health care provider fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

What drug tier is Keytruda typically on?

Tier 5

Medicare plans typically list Keytruda in Tier 5 of their formulary. Tier 5 drugs are usually non-preferred brand-name drugs. Tier 5 drugs cost more than Tier 1, 2, 3 and 4 drugs.

Does your plan have restrictions?

See discount prices that can save you money when your Medicare plan doesn't work for you.

Medicare prices are provided by the Centers for Medicare and Medicaid Services (CMS). They are accurate as-of July 2018 and the information may be updated. If you encounter any issues, please let us know.
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