CLL Therapy Covered by Medicare Parts A & B 

Cancer medicines that are FDA-approved and administered as an infusion by a licensed medical provider are covered by Medicare Part A and Part B. Part A refers to you receiving the treatment at a hospital and staying overnight (inpatient). Part B refers to you receiving the treatment at a hospital or clinic but don’t stay overnight (outpatient). 

• For Part A, if you stay in the hospital between 1-60 days in a benefit period, you pay $0 after you meet your Part A deductible of $1,632. To review the cost per day to stay in the hospital after 60 days, click here to learn more.
• For Part B, if you receive the treatment at a hospital clinic, you pay a copayment. If you receive treatment in a doctor’s office or freestanding clinic, you pay 20% of the Medicare-approved amount after you meet the Part B deductible. 

The CLL therapies this applies to include:

• Obinutuzumab (if used in the FDA-approved combination with venetoclax as a first-time treatment)
• Rituximab (if used in the FDA-approved combination with venetoclax as a second-line or subsequent treatment)
• CAR T-cell therapy liso-cel (as a third-line CLL treatment) 

CLL specialists often recommend obinutuzumab over rituximab for second-line treatment with venetoclax, but Medicare only approves obinutuzumab for first-line use as that is what is FDA-approved. Adding private insurance might help fill this coverage gap. 

CLL Treatments Covered by Medicare Part D 

Prescription medicines in the form of a pill taken by mouth like venetoclax and BTK inhibitors (acalabrutinib, zanubrutinib, ibrutinib, pirtobrutinib) are not covered by Medicare Parts A or B. They are, however, included in Medicare Part D. You can join a separate Medicare drug plan to get Part D coverage. 

Thanks to the signing of the Inflation Reduction Act (IRA) of 2022, the annual out-of-pocket (OOP) maximum you pay for these medicines starting in 2025 will be $2,000. Previously, there was no cap for OOP maximum costs. You’ll also have the option to pay these costs in monthly payments instead of all at once. 

Patients taking venetoclax will have lower OOP costs over time compared to patients taking BTK inhibitors because, in most cases, venetoclax is prescribed for a set period of one or two years and then stopped, whereas BTK inhibitors are taken continuously.