Procarbazine (Matulane)

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.

What it treats

Stage III and stage IV Hodgkin lymphoma, used in combination with other anticancer drugs.

What it is for, in depth

Procarbazine is one of the original Hodgkin lymphoma drugs, a component of the MOPP regimen that first cured advanced Hodgkin lymphoma in the 1960s and still used in BEACOPP-style regimens today. It is never given alone for this disease. Its long-term costs, infertility and second malignancies, are the reason modern Hodgkin protocols balance its effectiveness against these late effects and why survivors are monitored for years after treatment.

How it works

Procarbazine is an alkylating-type chemotherapy. After activation in the liver it damages cancer-cell DNA through several mechanisms, stopping the cells from dividing. It also has weak MAO-inhibitor activity, which explains some of its food and drug cautions.

How it is taken

Capsules by mouth on the schedule of the combination regimen (classically days 1-14 of MOPP or BEACOPP-type cycles), with blood counts checked before and during treatment.

Common side effects

['Nausea and vomiting', 'Low blood counts (infection, anemia, and bleeding risk)', 'Mouth sores', 'Hair loss', 'Loss of appetite']

Serious warnings

['Severe bone marrow suppression: serious drops in white cells, red cells, and platelets', 'Second cancers, including lung cancer, myelodysplastic syndrome, acute leukemia, and non-Hodgkin lymphoma, reported during and after treatment', 'Lung, liver, kidney, and nervous-system toxicity, and impairment of fertility in men and women']

Who should be careful

['People with kidney or liver impairment, who need close monitoring', 'Anyone with low blood counts before treatment', 'Men and women who wish to preserve fertility, who should discuss banking options first', 'Anyone who is pregnant; contraception is required']

Major interactions

['Alcohol, which can cause a disulfiram-like reaction (flushing, nausea, low blood pressure) and adds sedation; avoid before, during, and after treatment', 'Sympathomimetic drugs (such as some decongestants), tricyclic antidepressants, and high-tyramine foods, because of its MAO-inhibitor activity', 'Other sedatives and CNS depressants, whose effects are increased', 'Other bone-marrow-suppressing drugs, which add to low blood counts']

Cost and saving notes

Matulane is a brand-only specialty cancer drug with no generic; Part D plans place it on the specialty tier with prior authorization as part of a Hodgkin lymphoma regimen. Manufacturer copay cards cannot be used with Medicare; charitable foundations may assist. Ask about a tier exception and check Extra Help if your income is limited. 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

Procarbazine (Matulane) sits on Tier 5 in 96.78% of the plans that list it (5318 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 $8,181 per beneficiary for 2024 — a high-cost drug, 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

• MATULANE (PROCARBAZINE HYDROCHLORIDE) CAPSULE [LEADIANT BIOSCIENCES, INC.] — DailyMed
• MedlinePlus Drug Information

What official patient guides say

Take the capsules by mouth one or more times a day, at around the same time(s) every day, exactly as directed; do not take more or less of it or take it more often than prescribed. The length of treatment depends on the other drugs you are taking, how well your body responds to them, and the type of cancer you have, and your doctor may adjust your dose or stop your treatment for a period of time depending on your response and how you feel, so talk to your doctor about how you are feeling during your treatment. If you miss a dose, take it as soon as you remember it; however, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule, and do not take a double dose to make up for a missed one. Store the capsules in the container they came in, tightly closed and out of reach of children, at room temperature and away from light, excess heat, and moisture, not in the bathroom. Keep all appointments with your doctor and the laboratory; your doctor will order laboratory tests before, during, and after your treatment to check your body's response.

Source: MedlinePlus Drug Information

Part D formulary coverage

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

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 2026-11-08

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Procarbazine (Matulane) — 100% of plans. Most of those plans put it on Tier 5: 5,318 plans, 96.8% of the plans that list it. Other plans place it on Tier 1 (123 plans), Tier 4 (46 plans) or Tier 3 (7 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 5; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 5; Aetna Medicare Value Plus (PPO) puts it on Tier 5. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

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

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.