Trifluridine/tipiracil

Medicare

Part D (self-administered)

Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).

Commercial insurance

covered with prior authorisation

Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy. Plans require prior fluoropyrimidine, oxaliplatin and irinotecan for colorectal use.

Assistance programmes

• Taiho Oncology Patient Support
• 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

Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.

Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.

Appraised for

Metastatic colorectal cancer after standard therapies

Notes

Metastatic gastric or GOJ cancer after 2 or more therapies: TA669 (2021). With bevacizumab (SUNLIGHT) appraised 2024.

NHS England

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

Sources: NICE TA405 · SMC advice: trifluridine-tipiracil. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.