Does Medicare Cover Famotidine?
- Famotidine can help reduce discomfort and prevent complications associated with high stomach acid levels. Learn whether Medicare covers prescription famotidine.
Excess stomach acid can cause painful indigestion or heartburn, but it could also lead to several health conditions if left unaddressed. Therefore, your doctor may tell you to take a medication such as famotidine to make you more comfortable and prevent complications. This guide outlines everything you need to know about Medicare coverage for famotidine.
What Is Famotidine?
Famotidine is a type of H2 blocker used to reduce the symptoms and conditions caused by excess stomach acid. Your health care provider may recommend famotidine if you have heartburn, gastroesophageal reflux disease, Zollinger-Ellison syndrome or stomach ulcers.
You can purchase famotidine over the counter at a pharmacy to treat indigestion and heartburn. Prescription famotidine is stronger and comes in tablets or a liquid. How often you need to take famotidine depends on your condition. Some people take a single dose before bed, while others take between two and four doses throughout the day.
Some people experience side effects while taking famotidine. These may include:
- Constipation of diarrhea
- Hives or skin rash
- Breathing problems
- Difficulty swallowing
Does Medicare Cover Famotidine?
Your Medicare plan covers famotidine if it includes supplemental prescription drug coverage, although it's unlikely to cover famotidine AC. Therefore, 100% of Medicare Part D enrollees are eligible for famotidine coverage. Your Medicare Advantage plan may cover famotidine if your insurer provides prescription drug coverage as an enhanced benefit.
However, you're unlikely to be eligible for famotidine coverage if you only have Medicare Parts A and B (Original Medicare.) Original Medicare excludes medications with a few exceptions, such as injections directly administered by a health care professional.
How Much Does Famotidine Cost With Medicare?
Famotidine costs between $7 and $79 for 30 20-milligram tablets, although prices at your local pharmacy may differ. Expect to pay roughly this amount if your Medicare plan doesn't cover famotidine or if you're in the deductible stage of a plan with prescription drug coverage.
The deductible stage lasts until you satisfy your insurer's deductible requirements. The maximum Medicare Part D deductible is $480 ($505 in 2023), but Medicare Advantage deductibles are often substantially higher. On the other hand, some insurance companies charge lower deductibles or don't require deductibles, although these plans tend to cost more per month.
Your plan enters the post-deductible stage once you've paid your deductible. Your insurer then covers your famotidine prescription costs, although you may be responsible for paying a co-pay. Most insurance companies impose co-pays of $5 or less for famotidine.
Medicare Coverage Restrictions for Famotidine
If your Medicare prescription drug policy covers famotidine, you can expect unrestricted coverage. Generally, you don't need authorization from your physician, and your insurance company is unlikely to limit the number of famotidine tablets you can collect from your pharmacy.