Does Ayushman Bharat — Cover Targeted Therapy?

It depends on which drug you are taking and whether it appears on the current PM-JAY benefit list. Some oral targeted therapy drugs are included within oncology packages; many newer ones are not. Even when your drug is listed, the scheme reimburses at a fixed package rate, so there may be a remaining balance. Your financial counsellor can check your specific drug against the current list before your first cycle and tell you exactly what is and is not covered.

The ₹5 lakh ceiling covers the whole family, not just one member, and resets on the annual renewal date linked to your card rather than your treatment start date. Cancer treatment — particularly targeted therapy taken over many months — routinely exceeds this ceiling. Knowing your renewal date matters for planning. In Telangana and AP, your state scheme may provide support once the PM-JAY ceiling is reached, so asking your counsellor to check both at the same time is worthwhile.

Yes, in many situations. Both state schemes are designed to work alongside PM-JAY — covering costs that PM-JAY does not reach, or providing support once the PM-JAY ceiling is exhausted. Whether both apply to your specific treatment depends on your card status, the procedure and the hospital. A CION financial counsellor can check eligibility for both in the same appointment rather than requiring separate applications.

Several other routes are worth exploring. Many pharmaceutical manufacturers run patient assistance programmes that can substantially reduce the cost of their drugs for patients who meet income criteria. Where a generic version of your drug exists and your oncologist considers it clinically appropriate, the cost difference can be significant. Your financial counsellor and oncologist together can identify what is available for your specific drug and whether any of these routes applies to your situation.

The Jan Aushadhi scheme provides generic medicines — including some older targeted therapy drugs — at substantially lower prices than branded versions. Government cancer hospitals and AIIMS centres may have access to drugs through ICMR or state procurement programmes. The availability of specific drugs through these routes changes, so asking your team to check current options rather than relying on information from a year ago gives the most accurate picture. Your counsellor can advise on what is currently available for your specific drug.

Bring your PM-JAY or Ayushman Bharat card, your state health card (Aarogyasri or NTR Vaidya Seva), your Aadhaar card, your oncologist's treatment plan or prescription, and any previous treatment bills. If you have a private health insurance policy, bring that document as well. With these, the counsellor can check scheme eligibility, look up your drug against current listings, estimate your out-of-pocket costs and identify whether a manufacturer assistance programme applies — all in one session.