Does Medicare Cover Nitrofurantoin?

Having a urinary tract infection can be an uncomfortable experience, and it's important to access the right treatment as soon as possible. Knowing whether your health insurance can shoulder some of the costs can make getting the help you need significantly less stressful. This article explains whether Medicare enrollees are eligible for nitrofurantoin coverage. 

What Is Nitrofurantoin Used For?

Nitrofurantoin is an antibiotic commonly prescribed to treat or reduce the risk of urinary tract infections (UTIs). It's ineffective for treating viruses and other types of bacterial infections. The medication usually comes in tablet form, but you can also get nitrofurantoin liquid suspensions. 

Healthcare providers prescribe nitrofurantoin to children and infants older than 1 month and adults. Your doctor will determine your dosage based on several factors, which may include your age and body weight and whether you have an active UTI or need the medication to prevent a new infection. 

Nitrofurantoin Side Effects

Some people experience an upset stomach while taking nitrofurantoin, so your physician may recommend taking your medication with food or a glass of milk. Other reported side effects include:

• Changes in skin color
• Hives, rashes or itchy skin
• A general feeling of being unwell
• Cough
• Chest pain
• Fever
• Breathing or swallowing difficulties
• Swelling

Does Medicare Cover Nitrofurantoin?

Approximately 98% of Medicare plans cover nitrofurantoin if they include prescription drug benefits. Coverage restrictions for nitrofurantoin are rare.

Medicare Parts A and B generally exclude prescription medications, so you're unlikely to have nitrofurantoin coverage if Original Medicare is your only form of health insurance. However, many enrollees purchase additional prescription drug coverage (Medicare Part D) to top up their regular Medicare coverage. 

Your insurer may also agree to pay for nitrofurantoin if you have a Medicare Advantage policy. The likelihood of your insurer covering your medication depends on whether your plan offers prescription drug benefits. 

Medicare Part D and Medicare Advantage enrollees can determine their eligibility for nitrofurantoin coverage by consulting the formulary (list of covered medications). You'll usually find it listed under Tier 2. If you can't find nitrofurantoin, you could try looking for the brand names Furadantin or Macrodantin.

How Much Will I Pay for Nitrofurantoin With Medicare?

If your Medicare policy covers nitrofurantoin, how much you pay depends on your deductible. Some Medicare Part D and Medicare Advantage plans don't have deductibles, but these policies are relatively unusual and often come with hefty premiums. You must cover your deductible out of pocket before your insurer will pay for your prescription medications. 

Fortunately, nitrofurantoin is a relatively affordable drug. Nitrofurantoin retail prices vary between vendors, but most pharmacies charge up to $79 for 14 100-milligram capsules.

You'll usually pay a modest co-pay for your medication after meeting your deductible, and your insurance company will cover the remainder of the costs. You should expect to contribute up to $21, although not all insurers require co-pays.