Rituxan and Medicare

Does anyone out there know if Rituxan is covered by Medicare as a treatment for ITP? My wife is currently in remission (3+ yrs) following Rituxan infusions in 2011. Since she is now past 65, her primary insurance is Medicare. If she goes out of remission, she will likely try another round of Rituxan. Thanks for any information on this subject.

I found Rituxan listed in Medicare's 2015 formulary. Presumably, it's there in the 2014 one, as well. But I think your question might best be posed to your wife's Part D plan provider.

I noticed the same thing a couple of weeks ago when reviewing my mother's Medicare docs with her for 2015. As always, check with your provider to be sure. Medicare coverage is very complicated these days and the docs are less than completely clear about coverage for medications for rare disorders.

You also probably have to look at the disorder. Rituxan may be covered by Medicare but only for certain things.

My wife had her annual appointment with her hematologist today. She has reached 3 years of full remission following a round of 4 rituxan infusions in 2011. She is now 65 years of age which means that Medicare is now her primary insurance. Since rituxan was so successful for her the first time around (covered by our insurance at the time), I wanted to know if Medicare will now cover this if we try another set of rituxan infusions in the future.

I asked her hematologist if Medicare covers rituxan specifically for the treatment of ITP. His answer was that it does cover 80% of the cost. Supplemental insurance will cover most of the rest. Since Medicare is the primary insurance provider, all Medicare supplemental insurance (including Medicare Advantage plans), will follow Medicare's lead in approving the additional cost.

The problem I found with checking on this question directly with the supplemental insurance providers is they tell me, basically, their coverage depends on what Medicare approves. When I tried to ask Medicare - in this case a hypothetical question - they gave me the run-a-round and never answered me. It seems they are only geared to dealing directly with hospitals and clinics on actual cases.