Key takeaways:
- Immunotherapy uses your immune system to fight many conditions.
- Immunotherapy trains your immune system to treat different types of cancer and prevent allergic reactions.
- Private health insurance, Medicare, and Medicaid may cover immunotherapy. Patient assistance programs and other financial support could also help you pay for immunotherapy.
What is immunotherapy?
Immunotherapy includes many kinds of treatments that stimulate or suppress the immune system to help the body fight conditions including cancer and allergies.
Immunotherapy is used to treat many types of cancer including breast, lung, skin, and colorectal. This treatment teaches your immune system to find and destroy cancer cells. Immunotherapy may be combined with other cancer treatments such as radiation or chemotherapy.
Cancer immunotherapy is different from allergy immunotherapy, which slowly exposes your immune system to allergens over time. This treatment allows you to become less sensitive to the substance that causes inflammation or other reactions.
Why do many immunotherapy treatments cost so much?
Immunotherapy is a relatively new kind of cancer treatment. Immunotherapy medications often have high launch prices and high annual increases, according to a report from the Commonwealth Fund.
Treatments also are expensive because of research-and-development costs. Manufacturers may spend even more on sales and marketing. In addition, a drugmaker can have the exclusive right to sell a brand-name medication for more than a decade without competition from generics.
How much does it cost to have immunotherapy?
Like chemotherapy, cancer immunotherapy can be expensive. Costs vary based on several factors:
- The type of immunotherapy you receive
- How often you take immunotherapy
- Your insurance status and coverage
For example, Keytruda is an immunotherapy drug used to treat several kinds of cancers. This medication is usually given every 3 weeks at a doctor’s office or infusion clinic. According to the manufacturer,Keytruda’s listed price per dose is more than $10,000. Your out-of-pocket cost for this treatment depends on your insurance coverage and whether you have met your deductible.
There are some one-time treatments for certain cancers that have six-figure prices.
Allergy immunotherapy is far more affordable than cancer treatment. Often, people receive allergy injections. Sublingual immunotherapy (SLIT) — usually given by drops under the tongue — can cost less than allergy shots. According to Johns Hopkins Sinus Center, the cost for SLIT is about $2 a day for the average patient.
Do health insurance plans pay for immunotherapy?
Many private insurance plans, including Medicare Advantage plans, cover cancer immunotherapy. So does Medicare. These plans also may cover other types of immunotherapy.
Medicaid plans differ state to state. Check with your state’s program about immunotherapy coverage.
Sublingual therapy tablets for allergies may be covered by insurance. However, SLIT drops are considered an “off-label” use and usually are not covered by private insurance, Medicare, or Medicaid.
What resources can help pay for immunotherapy?
If you do not have insurance, you may qualify for a patient assistance program from the medication’s manufacturer. Keytruda, as mentioned earlier, is made by Merck. If you qualify, the Merck Access Program offers assistance with copay and drug costs.
There are organizations that help you pay for medications if you are uninsured. They can also help you cover out-of-pocket costs if you have insurance. Those groups include:
- PAN Foundation
- HealthWell Foundation
- Good Days
- Cancer Financial Assistance Coalition
- CancerCare
You may consider joining a clinical trial that gives you access to immunotherapy. The Cancer Research Institute provides a portal for cancer immunotherapy clinical trials.
Does Medicare cover immunotherapy costs?
Original Medicare covers cancer treatment medications under Medicare Part B when they happen in a doctor’s office or clinic. That coverage often includes IV infusions, which are often the delivery method for immunotherapy. You typically pay 20% of the Medicare-approved amount for your provider’s services after you meet the Part B deductible. In 2022, the Part B deductible is $233.
If your immunotherapy is delivered while you are admitted to the hospital, the coverage may fall under Medicare Part A.
Many Medicare Advantage plans also cover cancer immunotherapy. Check with your insurer for details. Out-of-pocket costs may vary.
Allergy immunotherapy via injections are covered by Medicare and may be under Medicare Advantage plans.
What conditions can immunotherapy treat?
Immunotherapy can treat many conditions, including:
- Psoriasis
- Rheumatoid arthritis
- Bladder cancer
- Blood cancers, including lymphoma and leukemia
- Breast cancer
- Colorectal cancer
- Kidney cancer
- Liver cancer
- Lung cancer
- Multiple myeloma
- Skin cancer, including melanoma
Can you negotiate the cost of immunotherapy?
Most people do not pay the list price of medications. Though immunotherapy is often very specific, there may be a less expensive alternative or generic.
Talk to your specialist about your financial concerns. Asking questions upfront can help you save on medications. Also, check out patient assistance programs for manufacturer discounts.
Are there affordable alternatives to immunotherapy?
There are different kinds of cancer treatments. They include:
- Surgery
- Radiation
- Chemotherapy
- Targeted drugs
- Immunotherapy
Immunotherapy can be most effective, or can work, when other treatments have failed. More traditional therapy is often an option and can be more affordable.
Ask your specialist about less expensive medications or less costly treatment combinations.
The bottom line
Immunotherapy is an emerging treatment for cancer and other conditions that can be very expensive. These treatments may be covered by private insurance, Medicare, or Medicaid. If you qualify, manufacturer patient assistance programs can help reduce your out-of-pocket costs. There are organizations that support people with cancer-related expenses. Asking your specialist about costs upfront may lead you to more affordable options for cancer treatment. Allergy immunotherapy is often far less costly than cancer immunotherapy.
