Does Medicare Cover Kayexalate?
- This article explains whether Medicare covers Kayexalate, a drug used to treat hyperkalemia. It also explores the cost of Kayexalate with and without insurance.
Kayexalate is an inexpensive medication, but the costs of your treatment can add up over time. Therefore, you may wonder whether Medicare covers Kayexalate or a similar alternative. Below, we'll explore Medicare coverage for Kayexalate, including average out-of-pocket costs and coverage limits.
What Is Kayexalate?
Your health care provider may prescribe Kayexalate if you have hyperkalemia (high levels of potassium in the blood). It's a branded medication containing the generic drug sodium polystyrene sulfonate.
Kayexalate works by preventing the absorption of potassium in your intestines. In contrast to other medications that treat hyperkalemia, Kayexalate passes into the intestines without entering the bloodstream.
Kayexalate comes as an oral suspension liquid or as a powder to mix with water or food. Alternatively, your doctor may administer your medication as a rectal enema. Avoid using laxatives while taking Kayexalate because emptying your bowels too quickly can make your medication less effective.
Side effects of Kayexalate may include:
- Stomach or rectal pain
- Low potassium levels
- Bloody stools or vomit
Does Medicare Cover Kayexalate?
Medicare is unlikely to cover Kayexalate. Original Medicare (Parts A and B) generally excludes prescription drugs, although it may cover certain medications given directly by a health care professional. However, these drugs are usually injectable medications that patients can't administer themselves.
Medicare Part D plans purchased through a private company cover prescription medications, and some Medicare Advantage (Part C) policies also include drug coverage. However, most privately-purchased Medicare plans don't cover Kayexalate.
On the other hand, it's still worth checking your plan's formulary in case your policy is one of the few that pays for this medication. You could also look for drugs containing the same active ingredient, such as:
- Generic sodium polystyrene sulfonate
What Will I Pay Out of Pocket for Kayexalate With Medicare?
You're responsible for paying the total cost of your prescription unless your Medicare plan covers Kayexalate. Fortunately, Kayexalate is a relatively inexpensive drug, costing roughly $45 for a 60 ml bottle of 15mg/60m solution.
If your insurer covers Kayexalate, it won't cover your medication costs until you meet your Part D deductible. Part D deductibles must not exceed $480 (increasing to $505 in 2023.) However, many companies set significantly lower deductibles than the legal maximum.
The post-deductible stage starts when you've spent an amount equaling your annual deductible on prescription drugs. At this point, your policy begins paying your medication costs, although many charge a co-pay. It isn't easy to pinpoint how much you should expect to pay, as Medicare coverage for Kayexalate is relatively rare. However, if you take advantage of coupons or discount plans, you may be able to obtain this medication for $8-$12, according to GoodRx.
Are There Medicare Coverage Restrictions for Kayexalate?
It's unclear whether Medicare plans covering Kayexalate impose coverage restrictions. Some may restrict the quantity of Kayexalate you can receive or ask your physician to certify that you need your medication to treat a health condition. You can learn about your insurer's coverage restrictions by reading your policy documents.