Does Medicare Cover Xofigo?

Medicare Benefits Solutions
Oct 20, 2020

Prostate cancer impacts about 3 million men in the United States, and many men may need to try several treatment options to slow or stop the spread of cancer. Xofigo offers a chance to extend the life expectancy of someone who has been diagnosed with prostate cancer that fails to respond to other forms of treatment. 

Medicare Benefits for Xofigo

You won’t find this medicine listed in your Part D prescription drug plan’s formulary, and that’s due to it being a transfusion that requires administration by a trained healthcare professional. Original Medicare’s Part A benefits will apply if you receive Xofigo during a stay in a skilled nursing facility after a qualifying surgery. Part A coverage will also apply to medications administered during hospice care, provided those medications are not intended to attempt curing the terminal disease — since Xofigo is not used to treat advanced prostate cancer, it may be covered for use during hospice care if the hospice doctor and Medicare agree it’s an appropriate treatment for comfort and quality of life.

Medicare Part B’s coverage rules apply to treatment received as an outpatient from a Medicare-approved facility and provider. Medical necessity under Medicare Part B’s rules may require proof that other treatment methods, such as surgery or hormone therapy, have been unsuccessful before it coverage for Xofigo infusions can be approved. If your doctor feels you may benefit more from treatment with Xofigo rather than trying these other methods, they may be able to help you receive conditional approval with the right documentation. Any diagnostic tests you may need while undergoing treatment with Xofigo should be covered by Part B benefits.

Treatment with Xofigo

As a potent medication used in the fight against prostate cancer, Xofigo, a brand name for the isotope radium-223, slows the spread of cancer in the skeletal system. It’s common for this treatment to be used once other attempts to stop prostate cancer from spreading have failed to work. 

There are significant side effects when undergoing treatment with Xofigo, which is why so much consideration is given to its use as a treatment. It’s unlikely for a doctor to prescribe this treatment as the first defense against early forms of prostate cancer given how potent this type of treatment is. Anyone undergoing treatment with Xofigo must be aware of dehydration, as well as monitor the proper disposal of their bodily fluids while taking radioactive medications like this. 

Regular blood tests are also a necessary part of treatment with Xofigo since a low blood cell count is common throughout the entire scope of the treatment plan. Your doctor will help you determine how often you should be monitoring your body’s response to Xofigo if treatment with this medication is deemed medically necessary.