Does Medicare Cover Fosamax?

In this article...
  • Your doctor may prescribe Fosamax to reduce the risk of fractures if you have osteoporosis. Learn about Medicare coverage for Fosamax, including typical co-pays.

According to the National Osteoporosis Foundation, around 10 million Americans have osteoporosis. This condition causes brittle bones and leads to an increased risk of fractures. Therefore, your doctor may recommend a medication such as Fosamax to reduce the risk of complications. 

Fortunately, Fosamax isn't an expensive drug. However, planning how to pay for your long-term care is still essential. Below, you can learn whether Medicare covers Fosamax, including information about co-pays and coverage restrictions.

What Is Fosamax?

Fosamax is a brand-name medication containing alendronate. Alendronate is a type of bisphosphonate that reduces the rate at which your body absorbs cells from your bones. It can reduce the chance of breaking a bone by increasing bone density over time. Your doctor may prescribe Fosamax if you have osteoporosis. 

This medication comes in several strengths, and you usually take it once daily or weekly on an empty stomach. Your doctor will determine the correct dosage based on your condition and overall health, and you should follow their instructions closely. 

Fosamax is unsuitable during pregnancy and breastfeeding. It's associated with irritation and ulceration of the esophagus. You can reduce the risk of esophagus problems by remaining upright for at least 30 minutes after taking your medication. 

Other potential side effects of Fosamax include the following:

  • Stomach pain
  • Heartburn
  • Muscle pain
  • Swallowing problems

Does Medicare Cover Fosamax?

Whether Medicare covers Fosamax depends on if you have supplemental prescription drug coverage (Part D). Medicare Part D provides additional benefits to Original Medicare, and you can purchase a Part D policy from a Medicare-approved insurance company. 

Original Medicare rarely covers self-administered medications, such as Fosamax. However, 100% of Medicare Part D plans cover Fosamax or a generic alternative. If your insurer doesn't cover Fosamax, ask your doctor to prescribe generic alendronate or another covered brand. 

Medicare Part D plans have a formulary that lists the drugs the policy covers. Therefore, you can determine your coverage for Fosamax by consulting this list. As they're relatively affordable, Fosamax and similar drugs usually come under the lowest formulary tier (Tier 1).

How Much Does Fosamax Cost With Medicare?

Most Medicare Part D plans include annual deductibles of up to $480 ($505 in 2023). Insurers can set their own deductibles up to this limit, with most charging around $367. Some companies don't charge deductibles, although this usually results in significantly higher monthly premiums. 

When your doctor prescribes Fosamax, you'll usually pay the entire cost of your medication until you've met your deductible. How much Fosamax costs out of pocket depends on your area and pharmacy, but the average cost is around $67.70 for three packs of four 70-milligram tablets. 

Your insurance coverage kicks in once you've satisfied the deductible, after which your insurance company pays most of your medication expenses. Some companies don't charge co-pays for Fosamax, while others require a nominal co-pay of up to $1 per prescription. 

Will My Medicare Part D Insurer Restrict Coverage for Fosamax?

You won't usually need to obtain prior authorization from your doctor for your Medicare Part D plan to cover Fosamax. However, many Part D insurers set quantity limits restricting how much of the drug your pharmacy can fill per visit. You can determine whether your plan includes quantity restrictions by consulting your policy documents.

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