Lutetium-177 vipivotide tetraxetan

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. Radioligand therapy given in nuclear medicine; HCPCS A9607. Paid separately under the hospital outpatient system; the six-dose course is spread over about eight months, so coinsurance recurs with each dose.

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. PSMA-positive disease on an approved PET scan, and prior androgen receptor pathway inhibitor (taxane no longer required since the 2025 label expansion).

Assistance programmes

• Novartis Patient Support (Patient Assistance NOW Oncology)
• 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

PSMA-positive hormone-relapsed metastatic prostate cancer after 2 or more treatments (VISION)

Notes

TA930, published 15 November 2023, does not recommend it: the cost-effectiveness estimates were above the range NICE considers an acceptable use of NHS resources, and the committee also concluded it was not suitable for the Cancer Drugs Fund. A second evaluation, of use after an anti-androgen but before a taxane, was terminated on 16 July 2026 because the company made no evidence submission (TA1179). Individual funding requests and a resubmission remain possible.

Sources: NICE TA930. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.