Medicare coverage for Opdivo for Stage IIIC?

Posted By
Elaine Block
11/9/2017 11:15pm
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Replies: 3

Has anyone had any success in getting Medicare to pay for Opdivo for Stage IIIC?  

My husband, David, had a melanoma removed from his back in May -- SNLB came back clean.  Then in July he had a newly discovered metastatic melanoma that was in transit to the lymph node removed from his back.  

He was scheduled to begin the ipi/nivo/nivo+ipi trial in the end of September, (just within the 10 week time limit) when our onc seemed to warn him off the trial. He was concerned that David might be randomized into the Ipi only arm and I think that, especially in light of the results of the most recent study finding Nivo superior to Ipi, he wanted us to consider waiting until Nivo was approved for Stage III melanoma, which he thought would be imminent.  

I understand that Nivo has now been added to the NCCN protocol for Stage III melanoma, but hasn't yet received FDA approval for Stage III -- we're assuming (as are the finance folks at Georgetown Lombardi) that Medicare won't pay for Nivo for Stage III until the FDA approves it.  In looking through posts here, though, I've read about a couple of people getting insurance coverage for Stage III and wondered if anyone has been able to get Medicare to pay for it.We are very uncomfortable not to be getting any adjuvant treatment.




Husband, David, diagnosed 5/2017, stage 3C

I have no information about Medicare coverage, but this latest post and related articles may be helpful ammunition:

For what it's worth. I wish you and your husband well, Elaine.  C

Not sure about Medicare but Aetna approved me for stage 3b 6 weeks ago.

Stage 3b, ipdivo failure, taf/mek currently . Starting 10/13/17

There's a great tool on that will help you see if they will cover it