NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)

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. Each component is billed separately; liposomal irinotecan (Onivyde) is the branded, reviewed component.

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. Plans compare NALIRIFOX against FOLFIRINOX and may require justification.

Assistance programmes

• Ipsen Cares
• 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

EU-licensed 2024 for first-line metastatic pancreatic cancer; NICE appraisal 2025. Check NICE.

Sources: NICE search: NALIRIFOX (liposomal irinotecan regimen). Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.