Medicare and Pluvicto

[Ampa]

Does anyone know if Medicare covers LU 177 infusions?

[Tall_Allen]

Yes, if you meet the requirements.

[ragnar2020 in reply to Tall_Allen]

Hi Tall Allen, Can you be more specific regarding the “requirements” or are they too complicated for a portal summation? Thanks.

[Foldem in reply to ragnar2020]

As I understand it, you must have received ADT and chemo before they will approve it.

[Ampa in reply to Foldem]

that is my understanding also.

[Tall_Allen in reply to ragnar2020]

(1) PSMA-avid on a PSMA PET/CT scan (I'd recommend an FDG PET/CT scan too, if you can get it approved)

(2) metastatic and castration- resistant

(3) Tried and failed abiraterone or enzalutamide

(4)Tried docetaxel

(5) Good bloodwork

[ragnar2020 in reply to Tall_Allen]

TA,

Thanks for taking the time to summarize the present Medicare guidelines. I dug into Medicare and found them. It will be interesting how long Novartis goes from the back-end “hail-mary” application of LU-177 to the front end of PCa care after biopsy and PSMA PET CT scanning to try attacking systemic PCa before HT ADT and chemo. Novartis is trying LU-177 pre-chemo now in an open trial, but a participant must have had HT. This is difficult for someone such as myself who has recently undergone CABG5 and has been diagnosed with CHF. Does one take the 10-20% risk of using HT with ADT for a MACE or continue using RT with the whack-a-mole concept when BCR arrives again? There is the overseas option for theranostic LU-177 and other combos prior to HT and/or chemo, and some men are doing that with varying degrees of success. The pursuit of life after PCa diagnosis is a complex chess game with an apparently smart yet nasty opponent.

[ragnar2020 in reply to Tall_Allen]

TA,

This is interesting:

auntminnie.com/index.aspx?s...

[Tall_Allen in reply to ragnar2020]

prostatecancer.news/2019/12...

[ragnar2020 in reply to Tall_Allen]

TA,

Thank you. Got it.

JPD

[leebeth]

Traditional Medicare or Medicare Advantage? Yes, for traditional but Advantage would vary with insurer.

Of course, needs to be prescribed within the guidelines of the indication.

[Ampa in reply to leebeth]

thank you! I am on traditional with AARP supplemental through United Health.

[leebeth in reply to Ampa]

Yes! My brother has that exact same insurance so I know for 💯% that it is covered.

[Ampa in reply to leebeth]

Thank you. I guess I can honestly say I have enough other stuff to worry about.