Medical Oncologist
Paying for treatment
Will Insurance or a Government Scheme — Pay for Alectinib?
Alectinib is taken as a daily tablet at home, and the cost in India can be significant. Whether a government scheme or insurance plan will cover it depends on which programme you belong to and what your documents actually say about oral targeted medicines.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed August 2026
- Coverage varies by scheme — PM-JAY, state Aarogyasri schemes, CGHS and private insurance each have different rules for targeted therapies.
- Read the policy carefully — The word 'cancer' in a policy does not guarantee alectinib is covered. Many plans exclude or sub-limit oral targeted medicines.
- Prior authorisation is usually required — Even where coverage exists, most schemes require your oncologist to apply before treatment begins.
- Assistance programmes exist — If no scheme applies, manufacturer and NGO assistance may reduce or eliminate the cost.
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Most government schemes in India cover cancer treatment but do not list alectinib as a named drug. Whether you are covered depends on which scheme you belong to, what your policy says about targeted therapies, and whether your oncologist can apply for prior authorisation or an assistance programme.
Does health insurance in India actually cover alectinib?
Alectinib is an oral targeted therapy, and that distinction matters for insurance. Many private policies treat oral cancer medicines differently from intravenous chemotherapy — sometimes excluding them entirely, sometimes placing them under a separate sub-limit.
Government schemes such as PM-JAY and state Aarogyasri programmes cover specific cancer treatment packages. Whether alectinib falls within an approved package depends on the scheme's current drug list, not on whether CDSCO has approved the drug.
Confirm coverage in writing before your first dose, not after. A verbal assurance from an insurance helpline is not the same as a written pre-authorisation.
What should I check with my insurer or scheme before starting?
- Read your policy document for the words 'targeted therapy', 'oral chemotherapy' or 'oral oncology' — the specific clause matters, not the general cancer section.
- Ask whether your policy uses a drug formulary and, if it does, confirm alectinib is listed on it.
- If you have an Ayushman Bharat card, ask your oncologist which cancer package code applies and whether alectinib sits within that package.
- If you are in Andhra Pradesh, confirm at the hospital's help desk whether your family is enrolled in Dr. YSR Aarogyasri and what the current cancer drug list covers.
- If you are in Telangana, ask at the Aarogyasri help desk in the hospital whether your case qualifies under the PM-JAY-linked state benefits.
- If you are a central government employee or pensioner, ask your CGHS office whether alectinib requires a specialist approval and which empanelled hospital to use.
- Ask your oncologist to apply for prior authorisation before your first dose — most schemes will not reimburse costs incurred without it.
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Which scheme or programme applies to your situation?
| Scheme / Programme | Who qualifies | Targeted therapy coverage | What to do next |
|---|---|---|---|
| PM-JAY (Ayushman Bharat) | Families in the SECC database; Ayushman card holders | Cancer packages are included; which drugs fall within each package varies and is updated periodically by the National Health Authority | Ask your oncologist for the applicable package code and request written pre-authorisation from the scheme desk before starting |
| Dr. YSR Aarogyasri (Andhra Pradesh) | AP residents below the state income ceiling; extends PM-JAY with a state supplement | State supplement can cover treatments beyond the base PM-JAY package; the active drug list changes — confirm at the hospital desk | Contact the hospital's Aarogyasri help desk before your first dose, not a general helpline — the desk has the current package list |
| AB PM-JAY–linked scheme (Telangana) | Telangana residents enrolled under PM-JAY | Follows the PM-JAY package structure; the applicable oncology package determines which drugs are included | Ask at the CION centre's scheme help desk which package covers your treatment and whether prior authorisation is needed |
| CGHS | Central government employees, pensioners and their listed dependants | Cancer treatment is covered at empanelled hospitals; oral targeted drugs typically require a specialist's prior approval | Obtain a written referral and specialist approval from your CGHS-empanelled hospital before starting; keep all approvals on file |
| ECHS | Ex-servicemen and their dependants with a valid ECHS card | Cancer treatment is covered; high-cost targeted drugs usually need a prior sanction from the competent authority | Apply for prior sanction through your nearest ECHS polyclinic before the first dose; sanction letters have an expiry date |
| Private health insurance | As per individual policy terms and waiting-period conditions | Frequently excluded or sub-limited under 'oral chemotherapy'; the exact policy wording governs, not a verbal assurance | Request a written pre-authorisation before the first dose and before each refill cycle; get every confirmation in writing |
| Manufacturer patient assistance (Roche India) | Eligibility set by income and clinical criteria determined by the programme; your oncologist submits on your behalf | Can provide alectinib at significantly reduced or no cost to eligible patients; separate from any government scheme | Ask your oncologist to initiate an application as early as possible; the CION team can advise on the process |
What can you do if no scheme covers alectinib?
Ask your oncologist to contact the manufacturer's patient access team. Roche India operates assistance programmes for patients who cannot meet the full cost, and your oncologist submits the application on your behalf. The CION team can tell you what stage the application is at.
Some NGOs in India assist specifically with the cost of cancer medicines. The hospital's social worker or patient support team can identify which ones are currently active and accepting applications for your situation.
If you have received a written insurance rejection, ask which clause was used to deny the claim. A named clause gives your oncologist something specific to challenge with a medical necessity letter, which sometimes leads to a successful appeal.
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Common questions
Frequently asked questions
Is alectinib listed on the PM-JAY drug formulary?
PM-JAY reimburses cancer treatment through package codes rather than a drug-by-drug list, so the question is which package applies to your treatment — not whether alectinib appears by name. The package list is maintained by the National Health Authority and updated periodically. Ask your oncologist which package code covers your case and request the answer in writing. The scheme desk at the hospital can then confirm whether the current version of that package includes alectinib before you start.
My policy says it covers cancer. Does that mean alectinib is included?
Not automatically. Cancer cover in most private policies applies to hospitalisation and intravenous treatment. Alectinib is a daily oral tablet taken at home, and many policies treat oral targeted therapies under a separate clause that is either excluded or capped under a sub-limit. Look specifically for the words 'oral chemotherapy', 'targeted therapy' or 'outpatient medication' in your policy document. If the wording is ambiguous, request a written pre-authorisation response before starting — do not rely on a phone assurance.
Can I claim reimbursement for alectinib I have already paid for?
Some schemes and insurers accept reimbursement claims, but most require prior authorisation obtained before the first dose. Claiming after the fact without prior approval is frequently declined. If you have already started treatment, submit the claim with a medical necessity letter from your oncologist explaining why the drug was clinically urgent. Keep all receipts and dispensing records. For future cycles, request written approval in advance of each dispensing date rather than paying first and claiming afterwards.
Does the Dr. YSR Aarogyasri scheme in Andhra Pradesh cover targeted therapies?
The Dr. YSR Aarogyasri scheme extends PM-JAY coverage with a state supplement and has expanded its cancer treatment list over time. Whether alectinib is within the current approved list depends on which package is active at the time of your treatment. Contact the scheme help desk at the treating hospital — not the general call centre — because the desk staff have access to the live package list and can give you a definitive answer before your first dose.
What is the Roche patient assistance programme and how do I apply?
Roche India runs patient access programmes that can provide alectinib at reduced or no cost to eligible patients. Eligibility is based on income and clinical criteria set by the programme. Your oncologist applies on your behalf — it is not something you submit directly. Ask your oncologist at CION to initiate the process as early as possible, because applications take time to process. This is separate from government scheme coverage, so a denial from PM-JAY does not affect eligibility for this programme.
Will trying to get scheme approval delay when I can start alectinib?
It can, which is why it is worth starting the process in the same week you receive the prescription. Pre-authorisation from government schemes typically takes several days to a few weeks. Ask the team at CION to help you submit paperwork as soon as the drug is prescribed. If your oncologist determines there is a clinical reason to begin immediately, they can document medical urgency — some schemes treat this as grounds for expedited review, though it is not guaranteed.