Does Medicare Cover Rituxan? 

Advancements in medical technology have provided seniors and retirees with greater life expectancy and improved quality of life. Among the most intriguing advances within this industry has been the creation of monoclonal antibodies. These antibodies are made by cloning white blood cells and hold a lot of promise for alternative therapies for treating diseases like cancer.

Creating monoclonal antibodies is complex, but the result can bolster the immune system in ways that would not have occurred naturally. This is a form of biotechnology since monoclonal antibodies are created in a lab. Rituxan is currently one of the more popular treatments available using monoclonal antibodies.

What is Rituxan?

Rituxan (rituximab) is an injectable medication that uses monoclonal antibodies to treat various medical conditions, including rheumatoid arthritis (RA). It was approved by the Food and Drug Administration (FDA) in 2006 for treating RA. In 2016, the FDA approved Rituxan for treating granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). The latter conditions are types of vasculitis, a condition in which the blood vessels become inflamed.

More recently, Rituxan has shown promise in treating certain cancers by acting on tumor necrosis factors (TNFs). When used in conjunction with chemotherapy and other traditional cancer therapies, Rituxan is one more tool doctors and oncologists can use to help seniors live longer lives in the face of diseases like cancer.

How does Medicare cover Rituxan?

Rituxan has been approved for use in people as young as two. Still, because seniors tend to experience higher rates of diseases like cancer, GPA and MPA, many retirees want to know whether Original Medicare benefits provide coverage for Rituxan. Although most prescription drugs are covered by Part D, there are exceptions. 

Medicare Part D supplies prescription drug benefits to Medicare recipients; however, this coverage only applies to medications that can be purchased from retail pharmacies. Since Rituxan is provided as an injection to be administered by a healthcare professional in a medical setting, Medicare Part D does not apply. With this stated, Medicare Part D may provide benefits for medications used in combination with Rituxan in the fight against conditions like cancer or RA.

Medicare Part B coverage and Rituxan

Rituxan is an injectable medication administered in a clinical setting, so it is considered an outpatient treatment. This means it falls under Medicare coverage through Part B, the outpatient benefit of Original Medicare insurance. As long as the use of Rituxan is deemed medically necessary, Medicare recipients can receive coverage for this treatment.

Under Part B, Medicare recipients pay 20% of all costs, while Medicare covers the remaining 80%. You must keep your premium current and meet your plan’s deductible to utilize your Medicare coverage under Part B.

Medicare Part A Coverage and Rituxan

When Rituxan is administered as part of a stay in a Medicare-participating hospital or skilled nursing facility (SNF), the treatment is covered by the inpatient benefits of Medicare Part A. This is not to be confused with the administration of Rituxan in a hospital’s clinical lab. Medicare Part A only covers treatments adjacent to an admittance in a facility. Simply visiting the facility for treatment because it is the only facility with the resources needed to provide treatment still means that care is considered outpatient in nature.

Other Medicare coverage for RA and cancer treatments

Medicare benefits can also be used for other parts of a cancer or RA treatment plan. For example, care options and services like visits with your doctor or oncologist are covered by Medicare Part B, as are imaging tests and diagnostic testing.

Medicare Part A supplies up to 60 days of full coverage for inpatient hospital stays, with an additional 30 days available for continued care. Medicare Part D provides ongoing coverage for prescription medications you purchase from a retail pharmacy and take at home. If you have questions about the specific benefits available under your plan, you are encouraged to contact your plan manager for more details and consult your Medicare Part D formulary for questions about coverage of specific prescriptions.

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