Vismodegib

Medicare

Part D (self-administered)

Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).

Commercial insurance

covered with prior authorisation

Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy.

Assistance programmes

• Genentech Access Solutions
• Genentech Patient Foundation: Free medicine for eligible patients regardless of insurance type.
• 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

Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.

Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.

Appraised for

Symptomatic metastatic or locally advanced basal cell carcinoma unsuitable for surgery or radiotherapy

Notes

TA489 recommendation 1.1 is a refusal for the licensed indication, with 1.2 protecting people already on treatment. But NHS England does fund vismodegib for a different group: Blueteq form VIS2 in section B of the national Cancer Drugs Fund list (version 1.408, 24 September 2026) has funded it routinely since 14 July 2021, with no technology appraisal number, for adults with at least six clinically evident non-locally advanced, non-metastatic basal cell carcinomas of which at least three are 5 mm or larger, with or without Gorlin syndrome, where the person is suitable for surgery but surgery alone has the potential for substantial disfigurement, on the recommendation of a specialised skin cancer or head and neck multidisciplinary team; the form records that this use, and the intermittent dosing schedules, are not licensed. Scotland: not recommended in the absence of a submission from the company (SMC 924/13), which is a non-submission rather than a refusal after appraisal.

Sources: NICE TA489. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.