Does Medicare Cover Aromasin?

In this article...
  • Aromasin is a costly drug prescribed to treat certain types of breast cancer. This guide explains how Medicare coverage for Aromasin works and what you'll pay.

If you're diagnosed with breast cancer, the last thing you want to worry about is the cost of your treatment. Unfortunately, many drugs used to treat breast cancer are expensive, but having adequate insurance coverage for prescription medications, such as Aromasin, can provide peace of mind. 

So, does Medicare cover Aromasin? This guide explains everything you need to know about Aromasin and Medicare, including common coverage restrictions and out-of-pocket costs. 

What Is Aromasin?

Your healthcare provider may prescribe Aromasin (branded exemestane) if you have breast cancer and have been through menopause. Exemestane is an aromatase inhibitor that reduces the amount of aromatase enzyme produced in the body. Lowering aromatase levels reduces the amount of estrogen in the blood by preventing the conversion of androgens.

Aromasin commonly features in treatment plans for breast cancer because reduced estrogen levels can stop breast cancer cells from growing. This treatment is only effective for hormone receptor-positive breast cancer. 

Usually, you'll start taking Aromasin after taking Tamoxifen for between 2 and 3 years. Aromasin could be an appropriate treatment to stop cancer from recurring or to treat active cancer if Tamoxifen doesn't work.

Most people take one Aromasin tablet each day. This medication can cause side effects, which may include:

  • Hot flashes
  • Sleep problems
  • Tiredness
  • Headache
  • Joint pain
  • Sweating
  • Loss of bone density
  • Vitamin D deficiency

Does Medicare Cover Aromasin?

All Medicare Part D plans (supplemental prescription drug coverage) cover generic exemestane, and some may cover branded versions, such as Aromasin. You can find out which exemestane medications your policy covers by reading the formulary. Aromasin and similar drugs are expensive, so you'll usually find them on the second-highest tier (Tier 4).

Medicare is significantly less likely to cover Aromasin if you only have Original Medicare (Parts A and B). While it's possible that Original Medicare may cover Aromasin when administered by a healthcare professional, it's unlikely to cover your medication if you take it yourself at home. 

If your supplemental prescription drug coverage plan doesn't cover Aromasin, it's worth revisiting your options with your doctor. Your doctor may agree to try a similar medication included in the formulary.

How Much Will I Pay for Aromasin With Medicare?

Aromasin costs about $341.08 for 30 25-milligram tablets without insurance coverage. You'll usually pay this amount out of pocket until your insurance becomes responsible for covering your prescriptions. This happens when you begin the post-deductible stage after paying your annual Part D deductible. 

How much you'll pay for your Part D deductible depends on your insurance provider, but companies can't charge more than $480 in 2022 and $505 in 2023. Many insurers opt to charge less than the maximum legal deductible, and more expensive policies may come with $0 deductibles. 

During the post-deductible stage, you'll only pay a small co-pay when you receive coverage for Aromasin. Not all insurers charge co-pays for this medication, and those that do usually charge $12 or less.

Medicare Coverage Restrictions for Aromasin

Coverage restrictions for Aromasin vary widely between policies and insurance companies. However, quantity restrictions and prior authorization requirements are relatively uncommon. You can check whether your insurer restricts Aromasin coverage by contacting the company's customer care center or checking your policy documents. 

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