Medications
Cabozantinib (Cabometyx)
A kinase-blocker tablet taken once a day on an empty stomach for kidney cancer (renal cell carcinoma), liver cancer, and certain thyroid cancers.
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 cabozantinib 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
Cabometyx treats advanced kidney cancer (renal cell carcinoma) — including as first treatment together with nivolumab — liver cancer (hepatocellular carcinoma) after sorafenib treatment, certain thyroid cancers that progressed after prior VEGFR-targeted therapy, and certain previously treated pancreatic and other neuroendocrine tumors in adults and in patients 12 years and older.
What it is for, in depth
Cabozantinib, sold as Cabometyx tablets, treats several cancers. It treats advanced kidney cancer, called renal cell carcinoma, including as a first treatment together with nivolumab. It treats liver cancer, called hepatocellular carcinoma, in people who were treated with sorafenib before. It treats certain thyroid cancers that got worse after prior VEGFR-targeted therapy. It also treats certain previously treated pancreatic and other neuroendocrine tumors in adults and in patients 12 years and older. It is a kinase inhibitor. It blocks several proteins, including MET and VEGFR, that help cancer cells grow, spread, and build new blood vessels. The tablets are taken by mouth once a day on an empty stomach, at least 1 hour before or at least 2 hours after eating. Cabometyx tablets should not be substituted for cabozantinib capsules. The matched tablet strengths are cabozantinib 20 MG Oral Tablet [Cabometyx], cabozantinib 40 MG Oral Tablet [Cabometyx], and cabozantinib 60 MG Oral Tablet [Cabometyx].
How it works
It is a kinase inhibitor that blocks several proteins (including MET and VEGFR) that help cancer cells grow, spread, and build new blood vessels.
How it is taken
It comes as tablets taken by mouth once a day on an empty stomach — at least 1 hour before or at least 2 hours after eating. Do not substitute Cabometyx tablets for cabozantinib capsules, and stop treatment at least 3 weeks before scheduled surgery, including dental surgery, as directed.
Common side effects
Used alone, the most common side effects are diarrhea, tiredness, sore red hands and feet (palmar-plantar erythrodysesthesia), decreased appetite, high blood pressure, nausea, vomiting, weight loss, and constipation. With nivolumab, common effects also include liver problems, mouth sores, rash, low thyroid, muscle pain, taste changes, belly pain, cough, and upper respiratory infection.
Serious warnings
Serious risks include bleeding (do not take it after a recent hemorrhage), tears or abnormal connections in the gut (perforations and fistulas), blood clots including heart attack, severe high blood pressure, heart failure, and severe diarrhea. Other warnings include liver damage, adrenal insufficiency, protein in the urine, jaw bone damage (osteonecrosis of the jaw), poor wound healing, thyroid problems, low calcium, a rare brain condition (RPLS), and harm to an unborn baby.
Who should be careful
People with a recent history of bleeding, liver impairment (dose is lowered for moderate impairment and the drug is avoided in severe impairment), high blood pressure, or planned surgery or dental work should be careful. People who could become pregnant should use effective contraception, and breastfeeding is not advised.
Major interactions
Strong CYP3A4 inhibitors require a lower Cabometyx dose if they cannot be avoided, and strong or moderate CYP3A4 inducers require a higher dose if they cannot be avoided, as the prescriber directs.
Cost and saving notes
If this drug is on your plan's list but the cost is high, you can ask your plan for a tier exception or check if you qualify for Extra Help with drug costs.
Why it is in its tier
Cabozantinib is most often placed on Tier 5. It is listed by 100.0% of Part D plans, and 96.91% of the plans that list it place it on Tier 5, so this is a very strong majority placement. Tier 5 is the specialty tier. People on this tier usually pay the highest percentage coinsurance, meaning they pay a share of the drug price instead of a small flat copay. That placement fits what the data shows. Cabometyx is a brand cancer drug, and its cost level is very high. CMS dashboard data puts average spending per beneficiary in 2024 at $132511.98. That figure is a CMS program average, not a copay and not what any one person pays. High-cost brand drugs like this are the kind placed on the specialty tier. Individual plans vary, so check your own plan for your exact cost.
Sources
- CABOMETYX (CABOZANTINIB) TABLET [EXELIXIS, INC.] — DailyMed
- MedlinePlus — National Library of Medicine
- MedlinePlus — Cabozantinib
What official patient guides say
Cabozantinib comes as a tablet and a capsule to take by mouth, taken once a day on an empty stomach, at least 1 hour before and 2 hours after eating, at around the same time every day. Take it exactly as directed, and swallow the tablets and capsules whole with a full glass (8 ounces, 240 mL) of water — do not split, chew, crush, or open them. Your doctor may lower your dose or pause or stop treatment if you have serious side effects, so tell your doctor how you are feeling during treatment. If you miss a dose, take it as soon as you remember, unless it is less than 12 hours until your next scheduled dose — then skip the missed dose and continue your regular schedule; do not take a double dose. Keep the medication in the container it came in, tightly closed, at room temperature away from excess heat and moisture, not in the bathroom, and out of sight and reach of children with safety caps locked. Dispose of unneeded medication through a medicine take-back program; do not flush it.
Source: MedlinePlus — Cabozantinib
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 |
|---|---|---|---|---|---|
| Cabometyx | Cabozantinib S-Malate | 50232 | 1.21673e+09 | 9182 | 1023 |
| Cometriq | Cabozantinib S-Malate | 202 | 3.3434e+06 | 41 | 3023 |
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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