Can Ayushman Bharat cover monthly medicines without breast tumor surgery?

Dear Rinku Saini Ji,

Yes, it is possible to receive monthly treatment for a breast tumour under the Ayushman Bharat (PM-JAY) scheme even if surgery is not performed, provided the treatment is medically required and covered under the scheme. Surgery is not mandatory to receive eligible cancer treatments under Ayushman Bharat.

However, the way medicines are provided under the scheme depends on the type of treatment prescribed by your oncologist.

Can Monthly Cancer Treatment Be Covered Without Surgery?

Yes. Ayushman Bharat covers several medical oncology treatments independently of surgery.

Treatment	Covered Under Ayushman Bharat?
Chemotherapy infusions	Yes, if medically indicated and provided at an empanelled hospital.
Targeted therapy infusions	Yes, if included in the approved PM-JAY package.
Hormone injections	Yes, when covered under the applicable package.
Breast tumour surgery	Covered if recommended and medically necessary, but not compulsory for medical treatment packages.

How Can You Receive Monthly Medicines Without Surgery?

If surgery is not advised or the patient chooses not to undergo surgery, eligible medical treatments can still be received by following the PM-JAY process:

• Daycare Admission: The patient is admitted to the hospital's daycare unit for a few hours to receive chemotherapy, targeted therapy, or hormone injections.

• Separate Treatment Packages: Medical oncology treatments are covered under separate PM-JAY packages and do not depend on undergoing surgery.

• Pre-Authorisation: Before each treatment cycle, the hospital obtains approval for the applicable package through the PM-JAY system.

• Cashless Treatment: The approved package generally covers the treatment session, doctor's consultation, nursing care, medicines administered during the visit, and necessary investigations related to that treatment cycle.

Why Can't Take-Home Tablets Be Provided Under Ayushman Bharat?

Ayushman Bharat (PM-JAY) is primarily a hospitalisation and daycare treatment scheme. It does not cover outpatient (OPD) consultations or medicines that patients take home, including oral cancer tablets dispensed from a pharmacy.

If your oncologist prescribes a tablet that needs to be taken daily at home, it is generally not covered under the PM-JAY package for pharmacy dispensing.

What Are the Alternatives for Take-Home Medicines?

If the prescribed medicine is a daily oral tablet, you may consider these government-supported options to reduce costs:

• AMRIT Pharmacies: Located in many government hospitals, these pharmacies offer several cancer medicines at significantly discounted prices.

• Pradhan Mantri Bhartiya Janaushadhi Kendras: These centres provide quality generic medicines at affordable prices, where suitable generic alternatives are available.

What Should You Do Next?

• Visit the Ayushman Mitra Help Desk at an Ayushman Bharat empanelled hospital.

• Meet a medical oncologist to discuss the recommended treatment plan.

• Ask whether your treatment qualifies under a PM-JAY medical oncology daycare package.

• Carry your Ayushman Bharat (PM-JAY) Card, Aadhaar card, previous medical records, biopsy reports, and any imaging reports during your visit.

How HexaHealth Can Assist You

We are a healthcare platform that helps patients access quality cancer care.

We can help you:

• Connect with experienced medical oncologists.

• Help you find the best Ayushman Bharat empanelled partner hospitals for breast cancer treatment.

• Verify whether your recommended treatment is covered under the PM-JAY scheme.

• Guide you regarding eligibility, documentation, and cashless treatment.

• Support you throughout your consultation and treatment journey.

Kindly Share the Following Details

• Your City and State.

Based on these details, we will help you connect with an experienced oncologist and the most suitable Ayushman Bharat empanelled partner hospital for your treatment.

We wish you strength, good health, and a smooth treatment journey.
Warm regards,
Team HexaHealth