Comprehensive medication guide to Padcev including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
With the PADCEV Copay Assistance Program, eligible commercially insured patients pay as little as $5 per dose (max $25,000 per year). Padcev is billed under the medical benefit (J9177), not pharmacy benefits. Medicare Part B typically covers it at 80% after deductible; Medicaid coverage varies by state.
Estimated Cash Pricing
$2,793 per 20 mg vial and $4,185 per 30 mg vial at list price; no generic is available. Eligible commercially insured patients may pay as little as $5 per dose through the PADCEV Copay Assistance Program.
Medfinder Findability Score
72/100
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Padcev (enfortumab vedotin-ejfv) is a prescription antibody-drug conjugate (ADC) approved by the FDA for the treatment of locally advanced or metastatic urothelial cancer (bladder cancer and cancers of the urinary tract) as well as muscle-invasive bladder cancer (MIBC) in certain patients. It was developed by Astellas Pharma in collaboration with Pfizer and received its first FDA approval on December 18, 2019.
Padcev is not a pill — it is administered intravenously (by IV infusion) over 30 minutes at a hospital, outpatient cancer center, or specialty infusion suite. It is given on Days 1 and 8 of a 21-day treatment cycle, either as a single agent or in combination with pembrolizumab (Keytruda) and/or berahyaluronidase alfa-pmph.
The landmark EV-302/KEYNOTE-A39 clinical trial showed that Padcev plus pembrolizumab nearly doubled overall survival compared to platinum-based chemotherapy in patients with locally advanced or metastatic urothelial cancer — median overall survival of 31.5 months vs. 16.1 months (HR 0.47; p<0.0001) — establishing the combination as the new first-line standard of care.
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Padcev is a Nectin-4-directed antibody-drug conjugate (ADC). It works by combining a targeting antibody (AGS-22C3) with a potent cytotoxic payload (MMAE — monomethyl auristatin E) via a protease-cleavable linker. The drug-to-antibody ratio is approximately 3.8 MMAE molecules per antibody.
When Padcev enters the bloodstream, the antibody component seeks out cancer cells displaying Nectin-4 on their surface — a protein overexpressed in most urothelial cancers. The antibody binds to Nectin-4, and the entire complex is internalized by the cancer cell. Inside the cell, lysosomal enzymes cleave the linker, releasing free MMAE into the cytoplasm.
MMAE disrupts microtubule polymerization — the process cancer cells need to divide — causing cell cycle arrest and apoptosis (programmed cell death). MMAE can also diffuse into neighboring cancer cells, creating a "bystander effect" that kills nearby Nectin-4-negative tumor cells. When combined with pembrolizumab, the immunogenic cell death triggered by MMAE also amplifies the immune system's ability to recognize and destroy cancer cells.
20 mg — Lyophilized powder for injection (vial)
Single-dose vial reconstituted with 2.3 mL sterile water; final concentration 10 mg/mL
30 mg — Lyophilized powder for injection (vial)
Single-dose vial reconstituted with 3.3 mL sterile water; final concentration 10 mg/mL
As of 2026, Padcev is not on the FDA drug shortage list. However, Padcev is not a retail pharmacy medication — it is an intravenous infusion that must be administered at a hospital, cancer center, or specialty infusion suite. Most infusion centers order Padcev on a per-patient basis rather than maintaining standing inventory, due to its high per-vial cost ($2,793–$4,185) and hazardous drug classification.
The primary access challenges for Padcev in 2026 are not supply-related but administrative: insurance prior authorization (PA) is required, prior to each patient's treatment cycle, and PA processing can take days to weeks. Geographic access is also a factor for patients in rural areas who may be far from oncology infusion centers experienced with ADC administration.
If you're struggling to find a facility near you that can administer Padcev, medfinder contacts infusion centers on your behalf to identify which ones near you can fill your prescription — and texts you results — so you spend less time on the phone and more time focused on your treatment.
Padcev is not a controlled substance and has no DEA scheduling requirements. However, as a complex oncology ADC requiring IV administration, specialized monitoring, and hazardous drug handling, it is exclusively prescribed by oncology specialists and administered in qualified clinical settings.
Medical oncologists (most common prescribers)
Urologic oncologists
Hematologist-oncologists at community cancer centers
Oncology nurse practitioners (NPs) and physician assistants (PAs) under oncologist supervision
Padcev cannot be administered via telehealth — IV infusions require in-person clinical administration. However, many oncology practices offer telehealth consultations and follow-up monitoring visits between cycles, making it possible for patients in remote areas to work with a major cancer center specialist remotely while receiving infusions at a local community facility.
No. Padcev (enfortumab vedotin-ejfv) is not a DEA-scheduled controlled substance. It has no abuse potential or addiction profile. There are no special controlled substance prescription requirements — no limit on days' supply per prescription, no mandatory prescription monitoring program (PMP) checks, and no restrictions on refills from a controlled substance perspective.
Padcev does require a valid prescription from a licensed oncology specialist and must be administered in a qualified clinical setting due to its hazardous drug classification and the need for specialized monitoring. However, these requirements are based on its oncology-class status and safety profile, not controlled substance scheduling.
Padcev carries a boxed warning for severe and potentially fatal skin adverse reactions, including Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Skin reactions of any kind occur in 55–70% of patients. Common side effects include:
Skin rash and maculopapular rash (23–24% of patients)
Pruritus (itching) — approximately 33% of patients
Peripheral neuropathy (tingling, numbness in hands/feet)
Fatigue
Alopecia (hair loss)
Nausea, diarrhea, constipation
Decreased appetite and weight loss
Dry eye, conjunctivitis, keratitis (eye problems)
Elevated liver enzymes (AST/ALT) and blood glucose
Serious side effects requiring prompt medical attention:
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) — potentially fatal skin reactions (BOXED WARNING)
Hyperglycemia and diabetic ketoacidosis (DKA)
Pneumonitis / interstitial lung disease (ILD)
Infusion site extravasation and tissue damage
Embryo-fetal toxicity (requires effective contraception during treatment)
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Pembrolizumab (Keytruda)
PD-1 checkpoint inhibitor that is used in combination with Padcev for urothelial cancer; also approved as monotherapy for cisplatin-ineligible patients in the first-line setting.
Erdafitinib (Balversa)
Oral pan-FGFR inhibitor approved for FGFR2/3-mutated locally advanced or metastatic urothelial cancer. Requires FGFR mutation testing; approximately 40% response rate in FGFR-positive patients. Preferred option for patients unable to receive IV therapy.
Nivolumab (Opdivo) + Gemcitabine/Cisplatin
FDA-approved in March 2024 combination for metastatic urothelial carcinoma. An alternative first-line option particularly for cisplatin-eligible patients where Padcev is contraindicated.
Gemcitabine + Cisplatin or Carboplatin
Platinum-based chemotherapy regimen; standard option for patients ineligible for or unable to access Padcev-based regimens. Widely available at most oncology infusion centers.
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Ketoconazole (and other strong CYP3A4 inhibitors)
majorIncreases MMAE exposure and toxicity risk by inhibiting CYP3A4 metabolism. Avoid coadministration.
Clarithromycin
majorStrong CYP3A4 inhibitor — increases free MMAE exposure. Avoid if possible; monitor closely if unavoidable.
Apalutamide (Erleada)
moderateStrong CYP3A4 inducer — may decrease MMAE levels and reduce Padcev efficacy. Use with caution and monitor.
Grapefruit / Grapefruit juice
moderateCYP3A4 inhibitor via intestinal absorption — may increase MMAE exposure. Avoid during treatment.
Etrasimod (Velsipity)
majorAdditive immunosuppressive effects with Padcev. Avoid coadministration; increased infection risk.
St. John's Wort
majorPotent CYP3A4 inducer — accelerates MMAE breakdown, potentially reducing Padcev effectiveness. Avoid completely.
Padcev represents a landmark advance in the treatment of urothelial cancer. Since its first approval in 2019, it has evolved from a later-line rescue therapy into the first-line standard of care for most patients with locally advanced or metastatic urothelial cancer when combined with pembrolizumab. The survival benefit demonstrated in EV-302 — nearly doubling median overall survival compared to chemotherapy — has fundamentally changed what patients with this disease can expect.
Despite its effectiveness, Padcev's access challenges — insurance prior authorization, high list cost, and the requirement for specialized infusion center administration — can delay treatment for patients who need it urgently. The PADCEV Support Solutions program (1-888-402-0627) is specifically designed to minimize these barriers, and robust copay assistance and patient assistance programs exist to reduce financial burden.
If you're navigating the process of finding where to receive Padcev infusions, medfinder is here to help. We contact infusion centers near you to identify who can administer your prescription, so you can focus on what matters most — your health and your treatment.
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Real-time availability
Medfinder is actively checking pharmacy inventory for Padcev. We don't publish a number until we have enough verified pharmacy checks to be accurate — start a search and our team confirms current availability near you, usually within 24 hours.
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