Does Medicare Cover Belsomra?

Experiencing insomnia can make it challenging to live life to the fullest. Sometimes, healthcare providers may recommend taking medication to help you fall and stay asleep. One example of such a medication is Belsomra. Belsomra could help relieve your symptoms, but it's also relatively expensive. Find out whether your Medicare coverage could help pay for Belsomra.

What Is Belsomra?

Belsomra is a medication used to treat insomnia (difficulty falling or staying asleep) in adults. It works by reducing the effects of a neurotransmitter called oxerin, preventing it from sending signals to your brain that it's time to wake up. 

Doctors usually prescribe the lowest possible dose of Belsomra to reduce the risk of side effects. The recommended starting dose is 10mg, although your healthcare provider may prescribe doses up to a maximum of 20mg if a lower dose doesn't work. Most people take their medication around half an hour before they want to go to sleep and at least seven hours before they intend to wake up. 

Belsomra Side Effects

Belsomra can be habit-forming and could worsen symptoms for people with depression. Potential side effects of Belsomra include:

• Daytime sleepiness
• Doing activities such as walking, eating or driving while asleep
• Difficulty moving and speaking while waking up
• Leg weakness
• Diarrhea
• Headache
• Cough 
• Strange dreams

Does Medicare Cover Belsomra?

Your policy type impacts whether Medicare covers Belsomra. Parts A and B usually exclude self-administered medications. However, you may be eligible for coverage if you have Medicare Part D (supplemental prescription drug coverage) or a Medicare Advantage plan with prescription drug benefits via a private insurance company. 

Roughly 61% of Medicare supplemental prescription drug plans cover Belsomra. Moderately-priced medications like Belsomra are usually Tier 3 drugs, so checking under Tier 3 of your formulary can clarify your eligibility.

How Much Does Belsomra Cost With and Without Medicare?

Belsomra costs somewhere between $478 and $532 without Medicare coverage for 30 10mg tablets. If your plan covers Belsomra, your coverage won't begin until you've met your policy's annual deductible. Medicare Part D and Medicare Advantage providers can set their own deductibles, although the legal upper limit for Part D deductibles is $545.

You'll enter the post-deductible stage after spending the equivalent of your plan's deductible. After that, you'll pay a copay whenever you receive coverage for Belsomra. Belsomra copays start at around $2, although some insurers charge as much as $464.

Medicare Coverage Restrictions for Belsomra

Medicare insurers often impose coverage restrictions for Belsomra. The most common restriction is quantity limits, which means that your pharmacy can only fill a limited amount of your medication. This restriction may be related to Belsomra's habit-forming potential. Prior authorization requirements are more uncommon.