Does Medicare Cover Aztreonam?

If your doctor prescribes aztreonam to treat an infection, you may wonder if your Medicare coverage can help with the costs. Below, you can find out which Medicare plans cover aztreonam and how cost-sharing works.

What Is Aztreonam?

Aztreonam is an injectable antibiotic medication. Doctors use aztreonam to treat certain bacterial infections or to reduce your risk of developing an infection after surgery, particularly colorectal surgery. 

Aztreonam vials contain a powder to combine with liquid. Doctors can administer it via a vein (intravenously) or into the buttock or thigh muscles. Sometimes, individuals administer aztreonam injections themselves at home. Your health care provider may recommend switching to an oral antibiotic once you begin feeling better. 

Aztreonam Side Effects

Aztreonam can sometimes cause unwanted effects. Potential side effects include:

• Feeling or being sick
• Diarrhea
• Stomach pain
• Irritation around the injection site
• Rash
• Breathing difficulties

Aztreonam Coverage

All Medicare prescription drug plans cover aztreonam. Therefore, your eligibility for aztreonam coverage depends on whether your Medicare plan includes prescription medications as a covered benefit.

Medicare Parts A and B (Original Medicare) don't usually offer this benefit, so you may not qualify if Original Medicare is your only coverage. Original Medicare occasionally covers medications given by a health care professional in a hospital or clinic, which may apply to aztreonam in some instances. For example, Original Medicare may cover aztreonam if your doctor gives you an intravenous injection in the hospital.

Otherwise, you have two options if you need medication coverage through Medicare: Medicare Part D or a Medicare Advantage plan. Both plan types are available from Medicare-approved private insurance companies. Medicare Part D is prescription drug coverage and acts as a supplement to Original Medicare. 

Meanwhile, Medicare Advantage plans replace regular Medicare coverage and must offer the same benefits as Parts A and B. However, many Medicare Advantage policies include extra benefits, such as medication coverage. 

How Much Does Aztreonam Cost With Medicare Coverage?

Without insurance coverage, aztreonam retails for around $240 for six 1-gram vials. Medicare Part D and Medicare Advantage enrollees must pay full price for their medication until they meet their annual deductible. 

our annual deductible depends on your plan type and insurer. Medicare Part D deductibles can't be higher than $545 in 2024 and $505 in 2023. However, many providers set lower deductibles than the legal limit.

Medicare Advantage deductibles can be significantly higher, although it's also possible to purchase policies with very low or even no deductibles. Typically, zero-deductible plans cost substantially more per month than policies with higher deductibles. 

Once you've satisfied your deductible, your insurance company becomes responsible for paying for your medication. However, you'll often have to contribute a small co-pay — average co-pays for aztreonam range between $5 and $40.

Medicare Coverage Restrictions for Aztreonam

Most Medicare plans providing drug coverage don't restrict access to aztreonam. Therefore, you're unlikely to need authorization from your health care provider, and your insurer won't usually restrict how much medication you can collect from your pharmacy per visit.