Does Medicare Cover Ethambutol?
- Ethambutol is an antibiotic that eliminates the bacteria that cause TB and prevents it from spreading. Discover how Medicare coverage for ethambutol works.
Tuberculosis is a potentially serious bacterial infection that usually affects the lungs. If you're diagnosed with tuberculosis, you'll want to begin treatment as soon as possible. Therefore, knowing whether your Medicare policy covers the drugs you need can be helpful. This guide explains which Medicare plans cover ethambutol.
What Is Ethambutol?
Ethambutol is an antibiotic used to treat tuberculosis (TB). It can also reduce the risk of a person with TB passing the infection to others. Doctors usually prescribe ethambutol alongside other medications.
This medication is available in a generic form and as a branded medication called Myambutol. It comes in tablets, and most people take one dose per day.
Some people experience problems with their kidneys, liver and eyes while taking ethambutol, so your doctor may request regular checkups and blood tests to monitor your body's reaction to your medication. It can also irritate the stomach, so your doctor may recommend taking your tablets with a meal or snack.
Ethambutol can also cause the following side effects:
- Reduced appetite
- Strange sensations in your hands and feet, such as numbness or pins and needles
- Itchy skin
Does Medicare Cover Ethambutol?
Medicare may cover ethambutol if you have a prescription drug plan. For example, 100% of Medicare Part D plans cover ethambutol.
Medicare Parts A and B are unlikely to provide ethambutol coverage because they exclude most prescription drugs. Therefore, many beneficiaries purchase a Medicare Part D plan (supplemental prescription drug coverage) alongside regular Medicare to ensure more comprehensive coverage.
You may also qualify for ethambutol coverage if you're a Medicare Advantage enrollee. Medicare Advantage plans are an alternative to regular Medicare Parts A and B and must provide the same benefits. However, a significant proportion of private insurance companies selling Medicare Advantage policies provide medication coverage as an enhanced benefit. If this applies to your plan, you'll likely be eligible for ethambutol coverage.
How Much Will I Pay for Ethambutol With Medicare Coverage?
Ethambutol costs around $78 to $107 for 60 400-milligram tablets without health insurance. However, some pharmacies charge as much as $326 for the same quantity. Therefore, it could be worth comparing prices at several pharmacies to find the best deal, and using discount coupons could substantially reduce your out-of-pocket costs.
Generally, you'll pay the entire cost of your ethambutol prescription if your Medicare plan doesn't include prescription drug benefits. Alternatively, you'll pay for your medication until you meet your deductible if your policy covers your prescriptions. Medicare Advantage deductibles vary widely between insurers, although your insurance company can't charge deductibles higher than $408 if you're a Part D enrollee.
Your insurer begins paying for ethambutol prescriptions once you satisfy your deductibles. Most companies charge modest co-pays for ethambutol. You should expect to contribute a co-pay of around $1.
Are There Medicare Coverage Restrictions for Ethambutol?
Medicare Part D and Medicare Advantage (with prescription drug coverage) beneficiaries are usually entitled to unrestricted ethambutol coverage.