Fluorouracil (5-FU)

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 J9190. When 5-FU is infused over 46 hours through an ambulatory pump at home, the drug and pump are paid under the Part B durable medical equipment benefit. Topical fluorouracil (Efudex) for skin lesions is Part D.

Commercial insurance

covered on label

Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens.

Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.

Notes

Generic backbone of colorectal, gastric, pancreatic, breast and head and neck regimens for 60 years; funded routinely. NHS England has required DPYD testing before fluoropyrimidines since 2020.

NHS England

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

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