Ayushman Bharat (PM-JAY) and Immunotherapy — What the Package Rates Actually Cover

Cancer treatment is covered under PM-JAY. Immunotherapy is the hardest case within it. The scheme pays a fixed package rate for an approved procedure, and the medical-oncology rates are built around conventional chemotherapy. Checkpoint-inhibitor drug costs sit far above them, so the scheme usually absorbs the care around the treatment, not the drug.

That is an uncomfortable answer, and it is the one families are least often given before they commit. It is not a reason to skip the scheme. Surgery, radiotherapy, chemotherapy, diagnostics and hospital admission for a side effect are all real cover, worth real money, and many patients on an immunotherapy pathway use the scheme heavily for exactly those things. What it will not usually do is fund the checkpoint-inhibitor drug itself.

This table is indicative and general, as of August 2026. The Health Benefit Package list and its rates are revised periodically by the National Health Authority, and states apply them through their own agencies. Nothing here is a coverage guarantee, and nobody — including us — can confirm your cover on your behalf. The only version that counts is the one the empanelled hospital's Ayushman Mitra desk puts in writing for your diagnosis.

PM-JAY does not work as a bill-reimbursement scheme. It works as a list of named packages, each with a code and a fixed rate. Oncology appears in the Health Benefit Package under three specialty families — medical, surgical and radiation oncology. Medical oncology is the one that governs a day-care infusion.

Package codes and rates are revised periodically by the National Health Authority, and the version in force in your state at the time you register is the one that applies. A list you found online last year is not a safe basis for planning.

Only hospitals empanelled with the National Health Authority can give cashless treatment under PM-JAY. Empanelment is hospital-specific and specialty-specific, and it is reviewed periodically. Check it yourself on the official empanelled-hospital search rather than relying on a list, and check it again on the day you register.

• The official hospital search — the National Health Authority runs a public empanelled-hospital search at hospitals.pmjay.gov.in. Filter by your state and district, then by the medical-oncology specialty, to see which centres near you are currently listed for that specialty.
• The helpline and the app — the PM-JAY helpline is 14555. The Ayushman app and the beneficiary portal will also confirm your family's eligibility and show your card details.
• The Ayushman Mitra desk — every empanelled hospital has a Pradhan Mantri Arogya Mitra desk. This is the person who registers you, raises pre-authorisation and can tell you what a package includes. Find that desk before you meet the billing counter, not after.
• Telangana — PM-JAY is run converged with the state scheme through the Rajiv Aarogyasri Health Care Trust, so the list you need is the state's empanelled-hospital list, and the annual ceiling on your card may be the state's enhanced figure rather than the national one.
• Andhra Pradesh — the scheme is administered as Dr. YSR Aarogyasri, again converged rather than parallel. The same rule applies: confirm your ceiling and your hospital's status with the state trust's desk.
• Specialty, not just the hospital — a hospital can be empanelled for some specialties and not others. Being on the list is not the same as being on the list for medical oncology.

The order matters more than most families realise. Eligibility is confirmed first, the hospital is chosen from the empanelled list second, registration happens at the Ayushman Mitra desk before admission, and pre-authorisation is approved before treatment starts. Treatment begun ahead of approval is commonly paid out of pocket.

1. 1

   Confirm the family is eligible

   Check on the beneficiary portal, the Ayushman app, the helpline on 14555, or at a Common Service Centre. You will need Aadhaar and the family or ration identifier used for the scheme.

2. 2

   Get or verify the card

   An eligible family that has never made a claim may still not hold a card. Senior citizens aged 70 and above register separately for the Ayushman Vay Vandana card, which carries its own top-up.

3. 3

   Check how much cover is left this year

   The limit is annual and shared across the family, other than the 70-plus top-up. A claim made in March affects what is available in September. Ask for the current balance, not the headline figure.

4. 4

   Choose from the empanelled list, filtered by specialty

   Use the National Health Authority search, filtered to your state, district and medical oncology. In Telangana and Andhra Pradesh, cross-check against the state trust's own list.

5. 5

   Register at the Ayushman Mitra desk before admission

   Go to that desk first, with the card, Aadhaar, the family identifier and your diagnosis and treatment-plan documents. Registering after treatment has started is the most common reason a claim fails.

6. 6

   Have pre-authorisation raised and approved

   The treating team raises a request for a specific package code. Ask which code, what its rate is, and whether the prescribed drug is inside it. Wait for the approval before the first cycle.

7. 7

   Get the gap in writing before you commit

   Once the package is approved, ask for a written list of what sits outside it — drug, biomarker tests, scans, supportive medicines. That written gap is the number your family actually has to plan around.

Keep every document from this process. If a claim is queried later, the pre-authorisation approval and the written package breakdown are what settle it. The same discipline applies to a private policy running alongside the scheme — and if an insurer has already turned you down, the practical next steps are set out in our page on what to do when an immunotherapy insurance claim is rejected.

Most families end up combining routes rather than finding one that pays for everything. The scheme covers the surgery, radiotherapy, admissions and diagnostics around the treatment. The drug cost is then met, reduced or avoided through a mix of the options below. None of them is certain to apply to you.

• Ask whether a biosimilar or domestically manufactured product exists — where one does, it is usually the single largest reduction available, and it changes the number without changing the treatment plan. Indicative August 2026 per-cycle drug cost runs roughly ₹50,000 to ₹1,50,000 for a domestic or biosimilar product against roughly ₹2,00,000 to ₹4,50,000 for an imported reference product. Raise it at the first consultation, not the fifth cycle.
• Manufacturer access and patient-assistance programmes — several manufacturers run dose-support or assistance schemes in India. Eligibility is narrow, documentation takes time, and applications usually have to be made before treatment starts. How these work in practice is set out in Patient Assistance Programmes: How They Work and How to Apply.
• A private policy running alongside the scheme — you cannot be paid twice for the same expense, and both the insurer and the scheme desk need to know about the other. Families commonly use the scheme for what it covers and the policy for what it does not. Confirm the arrangement in writing with both before cycle one.
• Discuss the length of the course honestly — how long treatment continues is a clinical decision, not a budgeting one, but it is entirely fair to ask early what the planned stopping point is and what happens when it is reached. That conversation is examined in Can You Take Fewer Cycles to Reduce Cost?
• Budget for the costs nobody quotes you — travel, an attendant's lost income, supportive medicines, repeat blood tests and accommodation add up quietly over a year of three-weekly visits. They are collected in The Hidden Costs of Immunotherapy Nobody Budgets For.
• Ask the hospital's medical social worker about other central and state funds — separate central assistance exists for poor patients treated at recognised cancer centres, and state chief minister's relief funds operate on their own criteria. These are slow, document-heavy and never guaranteed, but they are real and routinely under-used.
• Clinical trials are a clinical route, not a funding route — in some trials the investigational treatment is supplied by the sponsor, but eligibility is narrow and enrolment is never assured. A trial is entered for clinical reasons first.

The scheme is one piece. These pages cover the rest of the money question: what the treatment costs before any scheme is applied, what the manufacturers' own programmes can do, and what the treatment pathway itself looks like at CION.

• Immunotherapy Cost in India: Per Cycle & Full Course — the indicative numbers behind every figure quoted on this page.
• Patient Assistance Programmes: How They Work and How to Apply — the route most families reach for once the scheme gap is known.
• Can You Take Fewer Cycles to Reduce Cost? — the question to raise with your oncologist rather than decide alone.
• The Hidden Costs of Immunotherapy Nobody Budgets For — the year-long costs that sit outside every quote and every package.
• Immunotherapy at CION Cancer Clinics — how eligibility review, day-care treatment and monitoring run as one pathway.

Decisions for Healing, Not Billing

Cost and scheme cover are discussed openly at the first consultation — including the option of a plan your family can fund to the end, rather than one that stops halfway.