Enfortumab vedotin

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 J9177.

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.

Assistance programmes

• Astellas Pharma Support Solutions
• Seagen Secure (Pfizer)
• 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

Locally advanced or metastatic urothelial cancer after platinum chemotherapy and a PD-1/PD-L1 inhibitor

Notes

First-line combination with pembrolizumab (EV-302) appraised separately; check NICE for the current position.

NHS England

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

Sources: NICE TA982 · SMC advice: enfortumab vedotin. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.