Does Medicare Cover Flecainide?

In this article...
  • Flecainide is an inexpensive medication used to treat serious heart rhythm problems. Learn whether Medicare and Medicare Advantage plans cover flecainide.

Flecainide is a relatively affordable drug, but the costs could still be high if you need it for an extended period. This guide explains how Medicare coverage for flecainide works and what you should expect to pay out of pocket. 

What Is Flecainide?

Flecainide is an antiarrhythmic drug used to treat irregular heartbeats or chronic ventricular tachycardia. It comes in tablet form. Flecainide is the generic version of the drug, and doctors sometimes prescribe a branded version called Tambocor. 

This medication works by slowing down nerve activity in the heart tissue. However, it can sometimes trigger new heartbeat irregularities or cause an existing problem to worsen. Therefore, health care providers usually only prescribe flecainide for patients with severe or life-threatening heart conditions. 

Most people take two doses per day at regular 12-hour intervals. Flecainide is most effective when taken regularly, so skipping a dose could prevent it from working correctly. The correct dosage depends on various factors, including your weight, diagnosis and overall health.

Flecainide can cause side effects, and some of these effects may require medical attention. Commonly reported side effects of flecainide include:

  • Breathing difficulties
  • Tight sensation in the chest
  • Heartbeat changes
  • Wheezing
  • Feeling lightheaded or fainting

Does Medicare Cover Flecainide?

Whether your Medicare coverage includes flecainide depends on your plan type. Original Medicare enrollees are unlikely to receive coverage because Part A and Part B don't include prescription drug coverage as a benefit.

However, 100% of Medicare Part D plans cover flecainide specifically. Furthermore, you may be entitled to coverage if you have a Medicare Advantage plan (Part C.) Medicare Advantage policies must provide at least the same benefits as Original Medicare, but many also cover prescription medications. 

The easiest way to determine if your Medicare Advantage insurance covers flecainide is to read your policy's formulary (list of covered medications.) Insurance formularies have tiers — the higher the tier, the more expensive the drug. As a relatively inexpensive medication, flecainide often falls under Tier 2.

How Much Does Flecainide Cost With Medicare?

Enrollees must pay the full cost of their medication until they meet their plan's deductible. If you have Part D coverage, your Part D deductible can't be higher than $480 in 2022 or $505 in 2023. Medicare Advantage deductibles are often higher and vary significantly by provider. 

Flecainide costs vary by pharmacy, and most charge around $115 or less for 60 50-milligram tablets. A medication discount service could help you save money on your flecainide prescriptions. 

After meeting your deductible, most Medicare prescription drug plans pay the entire cost of your medication minus a nominal co-pay. Some policies don't impose co-pays for flecainide, and those that do typically charge $1 or less.

Does Medicare Coverage for Flecainide Include Restrictions?

Whether your plan restricts coverage for flecainide depends on your insurance provider. However, quantity restrictions and mandatory preauthorization are relatively unusual for this medication. 

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