# Medicare NCD 110.18: aprepitant for chemotherapy-induced vomiting

Source: https://onco.cc/terms/medicare-ncd-110-18/  
OnCo record `medicare-ncd-110-18` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Medicare Part B pays for an all-oral three-drug anti-sickness regimen, aprepitant with a 5-HT3 blocker and dexamethasone, for people receiving one of 20 listed chemotherapy drugs. It does not pay for aprepitant on its own.

## Summary

United States, Medicare National Coverage Determination 110.18, version 2, effective for services on or after 29 May 2013, implemented 7 July 2014. CMS defines highly and moderately emetogenic chemotherapy as agents so designated in at least two of three guidelines (NCCN, ASCO, ESMO/MASCC). The oral three-drug regimen of aprepitant, an oral 5-HT3 antagonist and oral dexamethasone is covered for beneficiaries receiving, alone or in combination, alemtuzumab, azacitidine, bendamustine, carboplatin, carmustine, cisplatin, clofarabine, cyclophosphamide, cytarabine, dacarbazine, daunorubicin, doxorubicin, epirubicin, idarubicin, ifosfamide, irinotecan, lomustine, mechlorethamine, oxaliplatin or streptozocin, and "must be administered immediately before and within 48 hours after" the chemotherapy. From April 2005 to May 2013 the list had nine agents.

Not covered under Part B: aprepitant alone, and regimens given partly by mouth and partly intravenously. Contractors may decide on other all-oral three-drug regimens using aprepitant or another FDA-approved oral NK-1 antagonist, with the listed agents or any other highly or moderately emetogenic chemotherapy.

## Fields

- Kind: Term
- Last checked: 2026-11-04
- Also known as: NCD 110.18; Aprepitant for Chemotherapy-Induced Emesis; Medicare oral antiemetic coverage
- Tags: us

## Notes

- Ondansetron is linked as an example of an oral 5-HT3 antagonist; the NCD names the class, not a drug.

## Sources

- CMS Medicare Coverage Database: the NCD: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=309&ncdver=2
- CMS Coverage API: the NCD text as data: https://api.coverage.cms.gov/v1/data/ncd?ncdid=309&ncdver=2

## Connected records

- technologies: [Antiemetics for chemotherapy-induced nausea and vomiting](https://onco.cc/technologies/antiemetic-therapy/)
- drugs: [Aprepitant (and fosaprepitant)](https://onco.cc/drugs/aprepitant/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Ondansetron](https://onco.cc/drugs/ondansetron/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [Centers for Medicare & Medicaid Services (CMS)](https://onco.cc/institutions/cms/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/), [National Comprehensive Cancer Network (NCCN)](https://onco.cc/institutions/nccn-org/)

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