Does Medicare Cover Intuniv?

The symptoms of ADHD can make social and work situations more challenging. Finding the correct medication can help, but many people worry about how to pay for long-term prescription drugs, such as Intuniv. Fortunately, some Medicare plans cover Intuniv or a similar alternative. 

What Is Intuniv?

Intuniv is a branded, extended-release medication containing guanfacine hydrochloride. It's a non-stimulating medication used to relieve the symptoms of attention-deficit hyperactivity disorder (ADHD), although your doctor may also prescribe Intuniv to reduce high blood pressure. 

Daily Intuniv dosages typically range between 1 and 4 milligrams. However, your doctor may recommend a different dosage schedule. Stopping your medication suddenly can cause unwanted effects, so healthcare providers often recommend reducing the amount you take gradually if you no longer wish to take Intuniv.

Intuniv Side Effects

Intuniv isn't habit-forming, so it's often a first-line treatment for children with ADHD. However, it can make some people feel lightheaded or sleepy, and drinking alcohol or using illegal drugs can make these symptoms more severe. Other possible side effects to be aware of include:

• Headache
• Irritability
• Reduced blood pressure
• Nausea
• Constipation
• Reduced appetite
• Fainting

Does Original Medicare Cover Intuniv?

Original Medicare (Parts A and B) doesn't usually cover prescription medications. However, there are exceptions. Original Medicare enrollees may be eligible for prescription medication coverage under limited circumstances. For example, it may cover the cost of drugs injected by a doctor in a hospital or outpatient clinic. However, this exception is highly unlikely to apply to Intuniv because most people self-administer their medication. 

Does Medicare Part D Cover Intuniv?

Roughly 77% of Medicare Part D (supplemental prescription drug coverage) plans cover Intuniv or another generic or branded guanfacine ER medication. If you're unsure which medications your plan covers, you can consult the formulary or contact your insurer's help center.

Does Medicare Advantage Cover Intuniv?

Whether your Medicare Advantage plan covers Intuniv partly depends on whether it includes prescription drug benefits. All Medicare Advantage plans must offer at least the same benefits as Medicare Parts A and B. However, many policies include additional benefits, such as vision care, dental care and prescription drug coverage. If your Medicare Advantage plan covers prescribed medications, you may have coverage for Intuniv. 

How Much Does Intuniv Cost With Medicare?

How much Intuniv costs with Medicare coverage depends on whether you're in the deductible or post-deductible stage. During the deductible stage, you're responsible for paying for your prescriptions until you meet your deductible. You should expect to pay between $32 and $322 for 30 1-milligram tablets until you spend an amount equal to your plan's deductible. 

During the post-deductible stage, your policy covers the cost of Intuniv. Whether you need to pay a co-pay depends on your insurance company and plan type. Generally, insurance companies charge co-pays of $20 or less for Intuniv.

Does Medicare Restrict Intuniv Coverage?

Coverage restrictions for Intuniv vary between policies and insurance companies. Many insurers require the doctor prescribing your medication to contact the company to state that it's medically necessary in a process known as prior authorization. Your insurance company will likely place restrictions on how many Intuniv tablets it covers per prescription.