Medications
Alectinib (Alecensa)
A twice-daily capsule (Alecensa) for non-small cell lung cancer that carries an ALK gene change — used after surgery to keep the cancer from coming back, and for metastatic disease; it blocks the ALK growth signal driving the cancer.
How Medicare covers it
Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.
| Coverage details | |
|---|---|
| Part B status | No alectinib row in the CMS Part B Spending by Drug HCPCS file (RY26, data through 2024) — no J-code basis; coverage path is Part D. |
| Medicare Advantage | Most Medicare Advantage plans that include drug coverage (MAPD plans) use the same formulary-and-tier system; the plan's own drug list decides coverage and copay — check the plan's formulary. |
| Medicare Supplement (Medigap) | Medicare Supplement (Medigap) plans sold today do not include prescription drug coverage; drug coverage comes from Part D or an MAPD plan. |
What it treats
ALK-positive non-small cell lung cancer (NSCLC) in adults: (1) as added treatment after tumor-removal surgery for ALK-positive NSCLC with tumors 4 cm or larger or cancer in lymph nodes, and (2) treatment of ALK-positive metastatic NSCLC. ALK status must be shown by an FDA-approved test.
What it is for, in depth
Alecensa is for adults whose non-small cell lung cancer tests positive for ALK. It has two labeled places in the treatment path: as adjuvant therapy after complete tumor resection in patients with tumors at least 4 cm or node-positive disease, to lower the chance of the cancer coming back, and as treatment for ALK-positive metastatic NSCLC. In both settings the cancer must be ALK-positive on an FDA-approved test — it is not for lung cancer without that marker. It is a long-term twice-daily oral therapy taken with food until recurrence, progression, or unacceptable toxicity. It comes in one strength, 150 mg capsules, with the usual 600 mg dose made up of multiple capsules.
How it works
Alectinib (brand Alecensa) is a kinase inhibitor that blocks ALK (anaplastic lymphoma kinase). In ALK-positive lung cancer, abnormal ALK signaling tells cancer cells to grow; blocking it slows or stops that growth.
How it is taken
Capsules by mouth, 600 mg twice a day, taken with food. Swallow capsules whole; do not open or dissolve them. Treatment after surgery and treatment for metastatic disease continue until the disease comes back or progresses, or side effects become unacceptable, with dose reductions if needed.
Common side effects
The most common side effects (20% or more) were liver test injury (hepatotoxicity), constipation, fatigue, muscle pain (myalgia), swelling (edema), rash, and cough.
Serious warnings
Serious risks include liver injury (liver tests are checked every 2 weeks for the first 3 months, then monthly), interstitial lung disease / pneumonitis (lung inflammation — stop the drug if this is confirmed), severe kidney impairment, slow heart rate (bradycardia) with low blood pressure, severe muscle pain with raised creatine phosphokinase (CPK), hemolytic anemia (red blood cell breakdown), sun sensitivity (photosensitivity — use sun protection during treatment and for 7 days after), and harm to an unborn baby.
Who should be careful
People with liver disease, lung disease, kidney impairment, slow heart rate or heart rhythm problems, or muscle disorders. It can harm an unborn baby — effective birth control is needed during treatment and for 5 weeks after the last dose, and patients should not breastfeed during treatment and for 1 week after. No contraindications are listed in the label.
Major interactions
The Alecensa label reports no clinically significant drug interactions requiring dose changes in its highlights; alectinib is broken down mainly by CYP3A, so prescribers review strong CYP3A-affecting drugs and any drug that slows heart rate, because bradycardia risk can add up.
Cost and saving notes
Medicare Part D facts that can help with cost: you can ask your plan for a tier exception or a formulary exception if the drug is not listed or is placed on a high-cost tier, Extra Help (the Part D low-income subsidy) lowers premiums and copays for people who qualify, and in 2027 Part D out-of-pocket drug spending is capped at $2,400 for the year. This does not state this drug's tier in any specific plan — check your own plan's drug list.
Why it is in its tier
Alectinib (Alecensa) sits on Tier 5 in 96.91% of the plans that list it (5325 of 5495 listing plans). Tier 5 is the specialty tier — instead of a flat copay, patients usually pay a percentage of the drug's cost (coinsurance), which is why specialty drugs feel expensive even with coverage. The data-visible drivers: It is a brand-only product with no generic version in the formulary data, and the CMS dashboard puts its average Part D spending at about $129,435 per beneficiary for 2024 — among the highest-cost drugs in the program, which matches where plans place it. It is listed by 100.0% of Part D plans. The tier shown is the most common one; individual plans vary.
Sources
- ALECENSA (alectinib hydrochloride) capsule — DailyMed
- MedlinePlus — National Library of Medicine
- MedlinePlus — Alectinib
What official patient guides say
You take this capsule by mouth with food, twice a day, at about the same times every day. Swallow the capsules whole — do not open or dissolve them. If you vomit after a dose, do not take another one right away; just continue your regular dosing schedule. If you miss a dose, skip it entirely and continue your regular schedule; do not take a double dose to make up for a missed one. While you are taking alectinib, and for at least 7 days after your last dose, avoid unnecessary or prolonged sun exposure (including sunlamps and tanning beds) and wear protective clothing, sunglasses, and sunscreen with an SPF of at least 50, because this medicine can make your skin sensitive to sunlight. Your doctor may pause your treatment or lower your dose if you have certain side effects, and will check your heart rate and blood pressure regularly. Keep taking it even if you feel well, and do not stop without talking to your doctor. Store it at room temperature in the container it came in, tightly closed, away from light, excess heat, and moisture (not in the bathroom), and out of the reach of children.
Source: MedlinePlus — Alectinib
Part D formulary coverage
| Formulary summary | |
|---|---|
| Most common tier | 5 |
| Plans listing this drug | 5495 |
| Total Part D plans | 5495 |
| Share of plans listing it | 100 |
| Formularies listing it | 286 |
| Tier | Plans |
|---|---|
| Tier 1 | 123 plans |
| Tier 2 | 1 plans |
| Tier 4 | 46 plans |
| Tier 5 | 5325 plans |
Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.
What you pay
| With Medicare Part D | |
|---|---|
| Most common tier | Tier 5 |
| Typical copay | $0 — half of plans charge between $0 and $0 |
| Typical coinsurance | 26.0% of the price |
| Based on | 5237 plans that cover this drug · 2027 plan year |
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.
Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07
Similar medications
Other medications in the same FDA pharmacologic class (Kinase Inhibitor):
Read next
Part D spending averages (2024)
| Brand name | Generic name | Total claims 2024 | Total spending 2024 | Total beneficiaries 2024 | Rank by beneficiaries 2024 |
|---|---|---|---|---|---|
| Alecensa | Alectinib HCl | 14597 | 2.46704e+08 | 1906 | 1544 |
Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30
Companies covering this drug
5,495 plans from 509 companies list this drug on a formulary for 2027. Search by company or plan name, or filter by tier. Cost sharing is the plan's published amount for this drug's tier in the initial coverage stage (1-month retail supply), where the plan publishes it; a blank means the plan does not publish it.
| Company | Plan | Tier | Copay | Coinsurance |
|---|
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.
Coverage and costs change. Drug lists (formularies), tiers, and copays can change during the year and differ by plan. Always check with your insurance company or plan directly to confirm what is covered and what you will pay.
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