Lutetium-177 dotatate

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 A9513. Four doses eight weeks apart.

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. Somatostatin receptor-positive GEP-NET on an approved PET scan.

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

Unresectable or metastatic, progressive, well-differentiated somatostatin receptor-positive GEP-NETs

NHS England

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

Sources: NICE TA539 · SMC advice: lutetium-177 dotatate. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.