Tebentafusp

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. Weekly infusion for HLA-A*02:01-positive uveal melanoma; first doses in hospital for CRS monitoring.

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. HLA-A*02:01 genotype must be documented.

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

HLA-A*02:01-positive unresectable or metastatic uveal melanoma

Notes

NICE recommended tebentafusp in January 2025 with a commercial arrangement.

NHS England

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

Sources: NICE TA1027 · SMC advice: tebentafusp. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.