Amivantamab

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. The subcutaneous formulation, if approved, remains clinician-administered and Part B.

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. EGFR exon 20 insertion or common EGFR mutation documented by an approved test.

Assistance programmes

• Johnson & Johnson withMe
• Johnson & Johnson 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.

Notes

Licensed 2022 for EGFR exon 20 insertion NSCLC after platinum; the first NICE appraisal did not recommend it. Later combinations (with lazertinib, MARIPOSA; with chemotherapy, PAPILLON) appraised 2025-26. Check NICE.

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