Understanding Medicare Coverage for Lymphoma CAR-T

Lymphoma treatments covered by Medicare Parts A and 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 and 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 lymphoma treatments used surrounding CAR-T that this applies to include:

• Lymphodepleting short-course chemotherapy before CAR-T:
  • Cyclophosphamide and fludarabine administered via IV
• FDA-approved CAR T-cell therapies:
  • Axi-cel (Yescarta)
  • Brexu-cel (Tecartus)
  • Liso-cel (Breyanzi)
  • Tisa-cel (Kymriah) 

Lymphoma treatments covered by Medicare Part D 

Prescription medicines in the form of a pill taken by mouth 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. If you need bridging therapy before CAR-T, these may include medicines in those regimens if they are pills. 

Thanks to the signing of the Inflation Reduction Act (IRA) of 2022, the annual out-of-pocket (OOP) maximum you pay for these medicines as of 2025 is $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.