COST, INSURANCE & FINANCIAL HELP
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Figuring out what you might pay out of pocket for a prescription medicine can be confusing. What you pay will depend on many factors, including your insurance situation and if there are financial support options available to you. At Merck, we believe that you should be better able to understand what you can expect to pay out of your own pocket for your prescription medicine.
The list priceThe list price is also referred to as wholesale acquisition cost or WAC. These terms refer to the manufacturer's price of the drug for wholesalers or direct purchasers in the United States, which does not include prompt pay or other discounts, rebates, or reductions in price. for each indicated dose of KEYTRUDA when given every 3 weeks is $11,564.16. The list price for each indicated dose of KEYTRUDA when given every 6 weeks is $23,138.32.* Most people will not pay the list price, although it may have an impact on your out-of-pocket costsOut-of-pocket costs are all the costs for medical care you have to pay for yourself because they are not paid for by your insurance. These costs may be reduced by supplemental insurance or manufacturer co-pay assistance programs.. The amount you pay will depend on many factors, including your insurance situation. The information below will help you better estimate what you may pay for your prescription medicine based on your insurance situation and also cover financial assistance that may be available to you.† For the actual out-of-pocket cost of your treatment, talk to your insurance provider, who knows the details of your plan if you have insurance, or contact your oncologist’s office for help.
*The indicated adult dose of KEYTRUDA is either 200 mg given every 3 weeks or 400 mg given every 6 weeks. KEYTRUDA is administered as an intravenous infusion over 30 minutes. Your doctor will decide how many treatments you need. Learn more about treatment schedules for KEYTRUDA. The list price does not include other treatment-related costs. The list price is current as of September 2024.
†The out-of-pocket costs below do not include the other medicines that you may take with KEYTRUDA or infusion center costs to administer KEYTRUDA or other medicines.
Choose an option below that best describes your insurance situation:
I have commercial insurance through an employer or a private policy that covers KEYTRUDA
For patients with commercial insurance who received a 200 mg dose, 59% of patients paid no out-of-pocket costsOut-of-pocket costs are all the costs for medical care you have to pay for yourself because they are not paid for by your insurance. These costs may be reduced by supplemental insurance or manufacturer co-pay assistance programs. for KEYTRUDA. For those patients who did have out-of-pocket costs, approximately 80% of patients paid between $0.01 and $375 per infusion, after satisfying their deductibleThe deductible is the amount you must pay out of your own pocket for your covered medical services each year before your insurance starts to pay. Once you reach your deductible, your insurance plan will begin helping you pay for covered medical services. Deductibles differ by plan. For help understanding your costs, contact your insurance company..1
- What you pay for KEYTRUDA will largely depend on your insurance plan. Each plan has different out-of-pocket costs for the medicines they cover, and most include an annual deductible. If you haven’t met your deductible, you may pay a higher out-of-pocket cost and could pay an amount closer to the list price above, until you meet your deductible.
If you are unable to afford KEYTRUDA, Merck may be able to help. Contact The Merck Access Program at 855-257-3932.
1Milliman, Inc., Expected Patient Out-of-Pocket Costs for Keytruda® (pembrolizumab), June 2024. Based on an analysis of 2021 and 2022 commercial and Medicare claims for 200 mg doses of KEYTRUDA. Commissioned by Merck Sharp & Dohme LLC a subsidiary of Merck & Co. Inc. Milliman’s analysis of a patient’s out-of-pocket payments for KEYTRUDA does not include contributions from secondary payers, manufacturer co-pay coupons, or other payments contributing to a patient’s liability due to limitations in its datasets. A patient’s true out-of-pocket payment may be less than the calculated patient liability illustrated in its analysis.
I have coverage for KEYTRUDA through Medicare (either through Medicare Advantage or traditional Medicare)
For patients with a Medicare Advantage plan who received a 200 mg dose, 39% of patients paid no out-of-pocket costs for KEYTRUDA. For those patients who did have out-of-pocket costsOut-of-pocket costs are all the costs for medical care you have to pay for yourself because they are not paid for by your insurance. These costs may be reduced by supplemental insurance or manufacturer co-pay assistance programs., approximately 80% of patients paid between $0.01 and $1,325 per infusion, after satisfying their deductibleThe deductible is the amount you must pay out of your own pocket for your covered medical services each year before your insurance starts to pay. Once you reach your deductible, your insurance plan will begin helping you pay for covered medical services. Deductibles differ by plan. For help understanding your costs, contact your insurance company.. For patients with traditional Medicare and no supplemental coverageSupplemental insurance is extra or additional insurance that you can obtain to help pay for medical services that your main insurance does not cover or to help pay your cost-sharing obligations under your main insurance. Not every patient has a supplemental insurance policy. (ie, a Medigap or Medicare Supplement plan), approximately 80% of patients paid between $1,300 and $2,100 per infusion, after satisfying their deductible.1 Many traditional Medicare beneficiaries, however, have supplemental coverage through their employer or a Medigap plan.2 This type of coverage often covers most or all of traditional Medicare Part B coinsurance or co-payments.3,4
- What you pay for KEYTRUDA will largely depend on your insurance plan. Each Medicare Advantage plan has different out-of-pocket costs for the medicines they cover, and most include an annual deductible. If you haven’t met your deductible, you may pay a higher out-of-pocket cost and could pay an amount closer to the list priceThe list price is also referred to as wholesale acquisition cost or WAC. These terms refer to the manufacturer's price of the drug for wholesalers or direct purchasers in the United States, which does not include prompt pay or other discounts, rebates, or reductions in price. above, until you meet your deductible.
If you are unable to afford KEYTRUDA, Merck may be able to help. Contact The Merck Access Program at 855-257-3932.
1Milliman, Inc., Expected Patient Out-of-Pocket Costs for Keytruda® (pembrolizumab), June 2024. Based on an analysis of 2021 and 2022 commercial and Medicare claims for 200 mg doses of KEYTRUDA. Commissioned by Merck Sharp & Dohme LLC a subsidiary of Merck & Co. Inc. Milliman’s analysis of a patient’s out-of-pocket payments for KEYTRUDA does not include contributions from secondary payers, manufacturer co-pay coupons, or other payments contributing to a patient’s liability due to limitations in its datasets. A patient’s true out-of-pocket payment may be less than the calculated patient liability illustrated in its analysis.
2Kaiser Family Foundation. Medigap enrollment and consumer protections vary across states, July 2018. https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states.
3Medicare.gov. How to compare Medigap policies. https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies. Accessed February 23, 2024.
4Medicare.gov. Get Medigap Basics. https://www.medicare.gov/health-drug-plans/medigap/basics. Accessed February 23, 2024.
I have coverage for KEYTRUDA through Medicaid
For most people on Medicaid, patient out-of-pocket costsOut-of-pocket costs are all the costs for medical care you have to pay for yourself because they are not paid for by your insurance. These costs may be reduced by supplemental insurance or manufacturer co-pay assistance programs. for prescription medicines like KEYTRUDA range from $4 to $8 per infusion.1 Your out-of-pocket costs may vary if you have a higher income. To learn more about Medicaid in your state and find out if you’re eligible, visit https://www.medicaid.gov/medicaid-and-you/index.html.
If you are unable to afford KEYTRUDA, Merck may be able to help. Contact The Merck Access Program at 855-257-3932.
1Centers for Medicare & Medicaid Services (CMS). Cost sharing out of pocket costs. https://www.medicaid.gov/medicaid/cost-sharing/out-of-pocket-costs/index.html. Accessed February 22, 2024.
I don’t have insurance or KEYTRUDA is not covered by my insurance plan
If you don’t have insurance coverage or your insurance does not cover your treatment with KEYTRUDA, you could pay an amount closer to the list priceThe list price is also referred to as wholesale acquisition cost or WAC. These terms refer to the manufacturer's price of the drug for wholesalers or direct purchasers in the United States, which does not include prompt pay or other discounts, rebates, or reductions in price. shown above, plus any additional charges depending on where you receive your medicine.
If you are unable to afford KEYTRUDA, Merck may be able to help. Contact The Merck Access Program at 855-257-3932.
Need more information about whether your insurance provider covers KEYTRUDA or about potential financial assistance options?
If you need further information or help paying for KEYTRUDA (with or without insurance coverage), Merck may be able to help. Contact The Merck Access Program at 855-257-3932. The Merck Access Program can help answer questions like:
Does my insurance cover KEYTRUDA?
What are the co-pay assistance options for eligible patients?
How can I find out if I’m eligible for the Merck Patient Assistance Program?
Merck provides certain of its medicines and adult vaccines for free to eligible patients who do not have prescription drug or health insurance coverage and who, without assistance, cannot afford the medicines and vaccines made by Merck. This is consistent with Merck’s long-held values and tradition of putting patients first.
Visit The Merck Access Program website for more information and to enroll.
To speak to a Merck Access Program representative: