Medicare does cover Krazati (adagrasib), almost always through a Part D prescription drug plan. The list price runs around $237,000 a year, but under the Inflation Reduction Act, a Medicare beneficiary’s out-of-pocket spending on Part D drugs is capped at $2,100 for all of 2026. Once you hit that ceiling, you pay nothing more for covered prescriptions for the rest of the calendar year.1Medicare.gov. Medicare and You2Managed Healthcare Executive. KRAS-Targeted Lung Cancer Drug Carries $237,000 Annual Price Tag
Why Krazati Falls Under Part D, Not Part B
Krazati is an oral tablet. Most oral cancer drugs are covered by Part D, the prescription benefit run by private insurers under contract with Medicare.1Medicare.gov. Medicare and You A narrow set of oral anticancer drugs can be billed under Part B when they share an active ingredient with an injectable version Medicare already covers, but Krazati has no injectable equivalent and does not qualify.3CMS.gov. Oral Anticancer Drugs
Because Part D is run through private plans, the tier Krazati sits on and the exact cost-sharing you see at the pharmacy depend on your specific plan’s formulary.4Via Benefits. Medicare Prescription Costs in 2026 The drug is also dispensed only through a limited network of specialty pharmacies, including Biologics by McKesson and Onco360 Oncology Pharmacy, so your plan will route the prescription accordingly.5BMS Access Support. Krazati Codes and Coverage
What You’ll Actually Pay in 2026
Two numbers do most of the work here. The Part D deductible can be up to $615 in 2026, and the hard annual cap on out-of-pocket Part D spending is $2,100.4Via Benefits. Medicare Prescription Costs in 20261Medicare.gov. Medicare and You
Krazati’s wholesale acquisition cost is roughly $19,750 a month. At that price, a typical Part D enrollee will blow through the deductible and reach the $2,100 cap inside the first month or two of therapy.2Managed Healthcare Executive. KRAS-Targeted Lung Cancer Drug Carries $237,000 Annual Price Tag Every covered Part D fill after that costs nothing for the rest of the year.
Before the Inflation Reduction Act, patients taking a high-cost specialty cancer drug like this could pay $11,000 to nearly $15,000 a year out of pocket for a single medication.6KFF. Changes to Medicare Part D Under the Inflation Reduction Act The cap took effect at $2,000 in 2025 and rose to $2,100 for 2026.1Medicare.gov. Medicare and You
Spreading That Cost Across the Year
Reaching the cap in the first fill means a bill of up to $2,100 at the counter in January or February. The Medicare Prescription Payment Plan, a free opt-in program open to any Part D enrollee, lets you pay nothing at the pharmacy and instead receive a monthly bill from your plan. The plan takes what you’ve accumulated in out-of-pocket costs and divides it by the number of months remaining in the year.7Medicare.gov. Medicare Prescription Payment Plan There is no interest and no late fee, though missing payments for two consecutive months past the due date can get you removed from the program.8PAN Foundation. Understanding the Medicare Prescription Payment Plan The total you owe does not change; it is just paid in installments.
Prior Authorization and Step Therapy
Nearly every Part D plan requires prior authorization before it will pay for Krazati. Criteria vary by plan, but common ones include:
- Prescribed by or in consultation with a hematologist or oncologist.
- Patient is 18 or older.
- Documented KRAS G12C mutation in locally advanced or metastatic non-small cell lung cancer (NSCLC) or, for the newer indication, colorectal cancer.
- For NSCLC, at least one prior systemic therapy. For colorectal cancer, prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy.9FDA. Krazati Prescribing Information
Some plans also impose step therapy, meaning you must try sotorasib (Lumakras), the other KRAS G12C inhibitor, before Krazati is approved. Cigna’s policy states that patients who have progressed on sotorasib should not then be treated with Krazati, and vice versa, because the two drugs work similarly.10Cigna. Krazati Prior Authorization Policy Centene-affiliated plans require sotorasib first unless the patient has a contraindication, significant adverse effects, brain metastases, or lives in a state where step-therapy restrictions on metastatic cancer treatments are prohibited.11Health Net (Centene). Krazati Clinical Policy Brain metastases is a common carve-out: Krazati may be approved as the first KRAS G12C inhibitor in that setting.
Approvals typically last 12 months. After that, your oncologist has to resubmit documentation showing the drug is still working and still needed.
If the Plan Says No
A denial is not the end. Start by asking the plan for a coverage exception, with your oncologist submitting a supporting statement explaining why Krazati is medically necessary. A standard exception decision is due within 72 hours; if waiting could harm your health, you can request an expedited decision, due within 24 hours.12Medicare Interactive. Introduction to Part D Appeals
If the exception is denied, the formal appeal process has five levels, starting with a plan redetermination filed within 60 days of the denial notice (7-day standard response, 72 hours expedited), then review by an Independent Review Entity on the same timelines. Later levels involve an Administrative Law Judge hearing, the Medicare Appeals Council, and ultimately federal district court; the amount-in-controversy thresholds in 2026 are $200 at the ALJ level and $1,960 for federal court.12Medicare Interactive. Introduction to Part D Appeals At any level, you can request expedited handling if your health is at risk. Medicare’s website offers a Model Coverage Determination Request form to begin the process.13Medicare.gov. Drug Plan Appeals
Help With What You Still Owe
One thing to know up front: Bristol Myers Squibb’s copay assistance program for Krazati is only open to commercially insured patients. Medicare, Medicaid, and other government-insured patients are not eligible.14BMS. Help Paying for Your Medicine This is a federal rule that applies across manufacturers, not something unique to BMS.
Independent charitable foundations are the usual route for Medicare patients. The HealthWell Foundation runs a Non-Small Cell Lung Cancer — Medicare Access fund that lists both adagrasib (Krazati) and sotorasib (Lumakras) as covered. Grants go up to $6,000, with a forecasted average utilization of $2,500, and can be used for prescription copays and Part B premiums. Household income must be at or below 500% of the Federal Poverty Level.15HealthWell Foundation. Non-Small Cell Lung Cancer — Medicare Access BMS Access Support can point patients toward foundation options and help with the prior authorization paperwork; the number is 1-800-861-0048.16Krazati.com. Krazati Support
A Note for Medicare Advantage Enrollees
If you are in a Medicare Advantage plan, your Part D benefit is bundled in, and the same $2,100 cap applies. What varies is the utilization management: MA plans use prior authorization, step therapy, and formulary tier placement to control costs on expensive drugs, and policies differ widely from plan to plan.17PMC. Medicare Advantage Utilization Management for Expensive Drugs Before starting treatment, pull up your plan’s formulary and prior authorization criteria for Krazati, or ask the plan directly, so you know in advance whether sotorasib will be required first.