Does Medicare Cover Macrobid?
- Macrobid is an antibiotic often used to treat urinary tract infections. Learn how Macrobid coverage works for Medicare Part D and Medicare Advantage enrollees.
Having a urinary tract infection can be uncomfortable, and your doctor can prescribe antibiotics or another medication to relieve your symptoms and treat the infection. If your health care provider prescribes Macrobid, you may want to know whether your Medicare coverage can assist with the costs.
What Is Macrobid?
Macrobid is a branded version of the antibiotic nitrofurantoin, used to treat UTIs. Health care providers sometimes prescribe this medication to prevent infections in people at higher risk of developing these conditions. Macrobid works by killing the bacteria that cause infections and preventing them from generating the nutrients they require to thrive.
The most common adult dosing regimen for treating UTIs is one 100-milligram tablet twice per day, usually at 12-hour intervals. Your doctor may prescribe a lower dose to prevent UTIs. Macrobid can irritate the stomach, so your health care provider may recommend that you take your medication with food.
This medication has several reported side effects. It can cause lung, liver and kidney damage with extended use, so it may not be the right option if you have a preexisting health condition affecting these organs. Some people also notice a change in the color of their urine while taking Macrobid.
Other side effects may include:
- Nausea or vomiting
- Stomach pain
Does Medicare Cover Macrobid?
As Original Medicare (Parts A and B) don't cover prescribed drugs, you'll only have coverage for medications if you have Medicare Part D (supplemental prescription drug coverage.) Part D plans are available from private insurance companies and improve your existing Medicare coverage.
You can purchase a Medicare Advantage plan instead of enrolling in regular Medicare. Medicare Advantage plans don't always offer broader coverage than Parts A and B, but many companies include prescription drug benefits in their coverage.
All Medicare Part D policies cover generic nitrofurantoin, and Medicare Advantage plans with medication benefits are also likely to cover this drug. Whether your policy covers the Macrobid brand depends on your insurance provider. Your insurer's formulary (covered medications list) can tell you which nitrofurantoin drugs your plan includes. Macrobid and other nitrofurantoin medications usually appear under Tier 2.
How Much Does Macrobid Cost With Medicare?
Macrobid retail prices vary somewhat between pharmacies and locale, but many charge around $42 to $106 for 14 100-milligram capsules without prescription drug coverage. Your coverage starts after meeting your plan's deductible, which is $480 or less ($505 in 2023) for Medicare Part D enrollees. If you're a Medicare Advantage beneficiary, your deductible depends on your insurer and policy type.
Most insurers impose co-pays for Macrobid prescriptions after you've met your deductible. You'll usually pay a co-pay of between $1 and $3 for Macrobid, and your insurance company covers the remaining costs.
Medicare Restrictions for Macrobid
Medicare prescription drug plans don't appear to routinely restrict coverage for Macrobid. However, rules vary between insurers, so your company may ask for authorization from your health care provider or cap how much medication your pharmacy can dispense.