Cabazitaxel

Medicare

Part B (clinician-administered)

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. Generics entered the US market between 2021 and 2024 after patent litigation.

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. Plans typically require prior docetaxel.

Assistance programmes

• Sanofi CareASSIST
• 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

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

Metastatic hormone-relapsed prostate cancer after docetaxel

NHS England

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

Sources: NICE TA391 · SMC advice: cabazitaxel. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.