Talimogene laherparepvec

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. Intralesional injection by the clinician; HCPCS J9325.

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

• Amgen SupportPlus
• Amgen Safety Net 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.

Appraised for

Unresectable regionally or distantly metastatic melanoma (stage IIIB-IVM1a) when systemically administered immunotherapy is not suitable

NHS England

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

Sources: NICE TA410 · SMC advice: talimogene laherparepvec. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.