Epcoritamab

Medicare

Part B (clinician-administered)

Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. Step-up dosing is often started in hospital (Part A) because of cytokine release syndrome monitoring, then continued in the outpatient setting. Subcutaneous, clinician-administered.

Commercial insurance

covered with prior authorisation

Covered under the medical benefit with prior authorisation confirming diagnosis, biomarker status and line of therapy; site-of-care policies may steer infusions away from hospital outpatient departments.

Assistance programmes

• myAbbVie Assist
• PAN Foundation — Disease-specific co-pay and premium funds; open and closed funds change monthly.
• HealthWell Foundation
• CancerCare Co-Payment Assistance Foundation
• Patient Advocate Foundation Co-Pay Relief
• Leukemia & Lymphoma Society financial support

20% Part B coinsurance on a high-cost infusion adds up quickly: Medigap Plan G or N, Medicare Advantage maximum out-of-pocket, Medicaid dual eligibility, or a charity fund are the usual buffers.

Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.

Appraised for

Relapsed or refractory DLBCL after 2 or more systemic treatments

Cancer Drugs Fund

Entered the Cancer Drugs Fund under a managed access agreement; check the current CDF list for whether it has since moved to routine commissioning.

NHS England

Routinely funded for the appraised indication (or via managed access)

Sources: NICE TA954 · NHS England Cancer Drugs Fund list · SMC advice: epcoritamab. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.