Medications
Brigatinib (Alunbrig)
A once-daily tablet (Alunbrig) for adults with a type of non-small cell lung cancer (NSCLC) that has spread and carries an ALK gene change; it blocks the ALK growth signal driving the cancer. Treatment starts with a 7-day lead-in at a lower dose (the initiation pack).
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 brigatinib 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
Metastatic non-small cell lung cancer that tests positive for the ALK gene change, in adults.
What it is for, in depth
About 3-5% of non-small cell lung cancers are driven by a rearranged ALK gene that acts like a stuck accelerator. Brigatinib was designed to shut that signal off, including in the brain, where this cancer often spreads and where it works after earlier ALK drugs in many patients. The first-week step-up in dose exists because lung inflammation, its most serious early side effect, is less likely when treatment starts low. Part D coverage is as a specialty-tier oral cancer drug with testing and diagnosis documented for authorization.
How it works
Brigatinib is a targeted kinase inhibitor. It blocks the abnormal ALK protein that drives this cancer's growth, which slows or shrinks the tumor.
How it is taken
Tablets by mouth once a day: 90 mg daily for the first 7 days, then 180 mg daily if tolerated.
Common side effects
['Diarrhea', 'Nausea', 'Tiredness', 'Cough', 'Headache', 'Rash']
Serious warnings
['Lung inflammation (interstitial lung disease/pneumonitis), most often in the first week; report new cough, breathlessness, or fever at once', 'High blood pressure, which needs monitoring and treatment', 'Slow heartbeat, vision changes, muscle damage, and high blood sugar or pancreatic enzyme elevations']
Who should be careful
['People with existing lung disease or breathing problems', 'People with high blood pressure, slow heartbeat, or heart disease', 'People with diabetes or pancreatic problems', 'Anyone who could become pregnant; effective contraception is required']
Major interactions
['Strong CYP3A inhibitors such as itraconazole, which raise brigatinib levels (dose reduction required)', 'Strong CYP3A inducers such as rifampin, which lower levels and can make it fail (avoid)', 'Grapefruit and grapefruit juice, which raise levels', 'Hormonal contraceptives, which may become less effective']
Cost and saving notes
Brigatinib (Alunbrig) is a brand-only specialty cancer drug. Part D plans place it on the specialty tier, usually with prior authorization confirming ALK testing and diagnosis. Manufacturer copay cards cannot be used with Medicare, but charitable foundations sometimes help with oral cancer drug costs. Ask about a tier exception, and check Extra Help, which can cut specialty costs sharply. The 2027 Part D out-of-pocket cap is $2,400 for the year, and the Medicare Prescription Payment Plan can spread that cost across the year.
Why it is in its tier
Brigatinib (Alunbrig) 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 $129,681 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
What official patient guides say
Brigatinib comes as a tablet you take by mouth once a day, with or without food, at around the same time every day. Swallow the tablets whole — do not chew or crush them — and take it exactly as directed; do not take more, less, or take it more often than your doctor prescribed. Your doctor may start you on a lower dose for the first 7 days and then raise it. If you vomit after a dose, do not take another dose; just continue your regular schedule. Avoid grapefruit and grapefruit juice while taking it. If you miss a dose, skip it and continue your regular schedule — do not take a double dose to make up for a missed one. If you miss 14 days or more, talk to your doctor before starting again, because you will probably have to restart at a lower dose. Keep all appointments with your doctor and the laboratory; your doctor will order lab tests and check your blood pressure before and during treatment. Store the tablets at room temperature, in the container they came in, tightly closed, away from extra heat and moisture and not in the bathroom, and keep them out of the sight and reach of children. Use a take-back program for medicine you no longer need, instead of flushing it.
Source: MedlinePlus — Brigatinib: MedlinePlus Drug Information
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 |
|---|---|---|---|---|---|
| Alunbrig | Brigatinib | 2175 | 4.18871e+07 | 323 | 2272 |
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.
Care and Living Guide is not connected with or endorsed by the U.S. government or the federal Medicare program. For official information visit Medicare.gov or call 1-800-MEDICARE.