Radium-223 dichloride

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. HCPCS A9606. Six monthly injections.

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. Symptomatic bone metastases without visceral disease, per the label.

Assistance programmes

• Bayer US Patient Assistance Foundation
• 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

Hormone-relapsed prostate cancer, symptomatic bone metastases and no known visceral metastases, only after docetaxel or where docetaxel is unsuitable

Notes

TA412 recommends it as an option only with the discount agreed in the patient access scheme.

NHS England

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

Sources: NICE TA412 · SMC advice: radium-223 dichloride. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.