Cancer Immunotherapy is a new form of cancer treatment designed to use your body’s own immune system to attack and prevent cancer cells from growing and forming. There are many types of immunotherapy and the costs of each type can vary drastically. However, cancer immunotherapy, in general, is very expensive and can cost more than $100,000 per patient.
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Costs of Cancer Immunotherapy
Immunotherapy has a lot of potential for future cancer treatment with several pharmaceutical industry companies working towards FDA approval. As of June 2017, the FDA has approved 32 different types of immunotherapies. These treatments have been approved for several different indications including but not limited to the following:
- Breast Cancer
- Brain tumors
- Prostate Cancer
However, as promising as immunotherapy seems, these treatments can be an incredibly costly investment for patients everywhere. Below is a table that outlines the potential costs of the different types of cancer immunotherapy.
Costs and Types of Immunotherapy
|Type of Immunotherapy||Explanation||Product||Price|
|Monoclonal Antibodies||Laboratory-made antibodies (immune system molecules) that target and attack cancer-specific genes or proteins||Nivolumab (Opdivo)||$6,580 per infusion|
|Pembrolizumab (Keytruda)||$10,268 a month|
|Avelumab (Bavencio)||$1,813 per unit|
|Oncolytic Virus Therapy||Laboratory-modified viruses that target and kill tumor cells||T-VEC (Imlygic)||$65,000 per year|
|T Cell therapy (CAR-T)||T-cells (important immune cells) that are removed from the patient, changed in the laboratory, and then put back into the patient||Tisagenlecleucel (Kymriah)||$475,000 per treatment|
|Axicabtagene ciloleucel (Yescarta)||$373,000 per treatment|
|Idecabtagene vicleucel (Avecma)||$437,968 per infusion|
|Cancer Vaccines||Exposes the patient to antigens (foreign protein) so that your immune system will recognize and attack cancer antigens||sipuleucel-T (Provenge)||$93,000 per treatment|
The prices listed above can seem incredibly daunting as the out-of-pocket costs of these treatments are not affordable for the majority of patients. However, some immunotherapy can be covered under Medicare.
Each part of Medicare can cover different parts of your immunotherapy treatment regimen. Below is a brief outline of what each part of Medicare might cover for your immunotherapy.
Costs of Medicare
Meals given at the hospital
Outpatient doctor’s visits
$170.10 monthly premium (adjusted based on income)
|Part C (Medicare Advantage)||A private plan that covers Part A + B that also can include prescription medication coverage||Check the Medicare website to compare plan premiums.|
|Part D||Prescription drug coverage for medications taken outside of a hospital or other healthcare facility||Check the Medicare website to compare plan premiums.|
|Medigap||Can cover extra costs not covered by the other Medicare costs (deductibles, copays, coinsurance)||~$150 per month|
For inpatient immunotherapy, Medicare Part A will cover your hospital expenses as soon as you meet the $1556 deductible limit. For outpatient immunotherapy, Medicare Part B can cover 80 percent of your treatment after you have met your $233 deductible. After that, you will be responsible for 20 percent of your treatment costs.
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Medicare Coverage for Keytruda and Opdivo
Keytruda and Opdivo are both FDA-approved immunotherapy drugs that Medicare typically will cover.
Keytruda is administered via infusion every 3 weeks and is considered an outpatient prescription drug. As such, Keytruda will be covered under Medicare Part B. According to Merck (the manufacturer of Keytruda), your out-of-pocket costs can range anywhere from $1,000-$1950 per Keytruda infusion. For many patients, this rate can still be very costly. Additional coverage can be acquired if you have Medicare Advantage (Part C) or Medigap. Depending on your plan, your Keytruda treatment might even be fully covered. In fact, according to Merck, 41 percent of patients with Medicare Advantage Plans had no out-of-pocket expenses.
For Opdivo, Bristol Myers Squibb (the manufacturer) claims that more than 60 percent of patients pay 25 percent of the original infusion price ($6,580). The cost of Opdivo can differ from $0-$8,210 per infusion based on your Medicare coverage.
How to Save Money on Cancer Immunotherapy
As mentioned previously, immunotherapy can be a very costly treatment. As such, a lot of immunotherapy manufacturers offer financial assistance programs. For instance, Merck, the manufacturer of Keytruda offers the Merck Access Program. This program can help answer questions about insurance coverage and can also tell you if you are eligible for co-pay assistance. Another example is the Bristol Myers Squibb (BMS) Patient Assistance Foundation. BMS is the manufacturer of Opdivo which is discussed above. Similar to Merck, BMS also can help you determine if you are eligible for financial assistance.
Other 3rd party organizations can also offer patient financial assistance. The following organizations can help you pay for your out-of-pocket immunotherapy costs.
- PAN Foundation
- Memorial Sloan Kettering Cancer Center
- Cancer Financial Assistance Coalition
- Cancer + Careers
Value of Cancer Immunotherapy
Cancer immunotherapy, also known as “immuno-oncology” is incredibly promising and can permanently change the way cancer is treated in the future. The current standard of therapy for cancer includes surgery, radiation, and chemotherapy. Although these types of treatment have proved to be effective in extending the life of cancer patients, especially in patients who are diagnosed early, these treatments have failed to treat patients with late-stage diseases. Additionally, these therapies have a whole host of serious side effects that can irreversibly damage and disfigure patients. This can contribute to a decrease in the quality of life of patients even if their cancer has been eliminated.
Immunotherapy can be considered “targeted therapy” as opposed to radiation and chemotherapy which are viewed as systemic. Targeted therapy has a number of possible benefits in terms of both minimizing side effects and also reducing recurrences. This approach is significantly more precise and can be more personalized.
The discovery of immunotherapy has also contributed to an increased interest in “personalized medicine.” This means that therapy can be modified and adjusted based on individual patient needs and values. However, as discussed earlier, a major hurdle of cancer immunotherapy is the cost. As these drugs are incredibly novel and difficult to mass-produce, the cost is not easily affordable by most individuals. As a result, immunotherapy is still often only used as a last resort in cancer patients.
Cancer Immunotherapy Frequently Asked Questions (FAQs)
Below are some questions to consider if you are interested in cancer immunotherapy or have concerns about side effects and preparation.
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Am I a good candidate for immunotherapy?
The ideal candidate for immunotherapy is a patient with a relatively healthy immune system as immunotherapy involves utilizing the body’s own immune system to fight off tumor cells. This generally excludes patients that are older than 65 years of age or patients that are immunocompromised. Specifically, patients with non-small cell lung cancer are excellent candidates for immunotherapy. Additionally, certain patients with specific genes or molecular features can be at an advantage when trying immunotherapy.
How do I prepare for immunotherapy?
If you are about to undergo immunotherapy, it is important that you prepare your body for this procedure. The best way to prepare for this treatment is to stay as healthy as you can and to boost your immune system. Check out this article to see which supplements are best to boost your immune health. Besides supplements, you want to make sure to quit smoking, avoid alcohol, eat a well-balanced diet, and stay hydrated.
What are the side effects of immunotherapy?
Common symptoms of immunotherapy include
- Skin rashes or itching
Serious symptoms of immunotherapy include:
- Severe diarrhea
- Severe hormone changes
- Fatal allergic reactions/anaphylaxis
- Swelling of organs
Side effects of immunotherapy differ from person to person but in general, this therapy is well-tolerated. About 5-10% of patients taking immune-checkpoint inhibitors (the most common type of immunotherapy currently) experience serious side effects. Only 1-2% of patients experience life-threatening allergic reactions. Generally, most patients report feelings of fatigue as the most common symptom.
Cancer immunotherapy is a revolutionary new form of cancer treatment and has the potential to change the scope of cancer treatment across the board. However, as of 2022, this type of therapy can be incredibly costly. Government health insurance programs such as Medicare can assist you in paying for these costs. Additionally, it is very important to talk to your primary care provider or your oncologist about whether or not these treatments are appropriate for you.
The best way to detect cancer early or to even prevent cancer entirely is to engage in consistent doctor check-ups. Mira can help you engage in preventative care by providing affordable doctor visits in addition to access to urgent care and prescription medications. Join Mira today!