16
Treatment
Table 1. CMS Reimbursement and Oral Drug Prices —
Regimens and Prices for Treatment of Stage IV
NSCLC with Driver Alterations
Agent,
Route,
Treatment
Setting
HCPCS
CODE Dose Schedule
2020 Medicare
Drug Prices
(part D)
Price (USD) for
monthly dose Schedule
Erlotinib 150 mg Daily 4,215 150 mg daily
Osimertinib 80 mg Daily 16,597 80 mg daily
Gefitinib 250 mg Daily 8,110 250 mg daily
Dacomitinib 45 mg Daily 14,155 45 mg daily
Afatinib 40 mg Daily 10,282 40 mg daily
Icotinib 125 mg
× 3
ree
times
daily
N/A 125 mg three
times daily
Crizotinib 250 mg Daily 10,179 250 mg daily
Ceritinib 150 mg
× 5
Daily 21,107 750 mg daily
Alectinib 150 mg
× 8
Twice
daily
15,789 600 mg twice
daily
Brigatinib 90 mg Daily 16,779 90 mg daily
Lorlatanib 100 mg Daily 17, 288 100 mg daily
Entrectinib 200 mg
× 3
Daily 18,380 600 mg daily
Dabrafenib 75 mg
× 4
Twice
daily
11,600 150 mg twice
daily
Trametinib 2 mg Daily 9,748 2 mg daily
Vemurafenib 240 mg
× 8
Twice
daily
11,852 960 mg twice
a day
Capmatinib 200 mg
× 2
Daily 10,559 400 mg daily
Tepotinib 500 mg Daily N/A 500 mg daily
Selpercatinib 80 mg
× 2
Daily 11,310 160 mg daily
Larotrectinib 100 mg Daily 17,493 100 mg daily
