Sipuleucel-T

Medicare

Part B (clinician-administered)NCD 110.22

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. National coverage under NCD 110.22 for asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer; HCPCS Q2043.

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.

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

Asymptomatic or minimally symptomatic metastatic hormone-relapsed prostate cancer

Notes

Never marketed in the UK; EU licence withdrawn 2015.

Sources: NICE TA332. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.