Does Medicare Cover Oxybutynin?

In this article...
  • Oxybutynin can reduce symptoms such as frequent urination in people with overactive bladders. This guide explains Medicare Part D coverage for oxybutynin.

If you have an overactive bladder, finding an effective treatment can help you manage your symptoms and enjoy an unrestricted lifestyle. Planning how to pay for your medication provides peace of mind, so it's worth understanding how Medicare coverage for oxybutynin works.

What Is Oxybutynin?

Oxybutynin helps reduce the symptoms of an overactive bladder, such as incontinence or frequent urination. It's a type of antispasmodic drug that works by reducing smooth muscle contractions in the bladder. The medication comes as a tablet, extended-release tablet or syrup.  

Doctors may prescribe oxybutynin to adults and children aged 6 or older. Most adults begin with a dose of 5 or 10 mg per day on an empty stomach, although you may require up to 30 mg if your symptoms are severe. Your doctor will tailor your dosage to your needs, so you should defer to their instructions if they differ from the guidelines on the packaging. 

Some people develop eye pain or hives while taking oxybutynin — you should contact your doctor if you experience either of these symptoms. The following side effects of oxybutynin require urgent medical attention:

  • Confusion
  • Seizures
  • Fever
  • Abnormal heartbeat
  • Hallucinations
  • Breathing difficulties
  • Facial redness
  • Extreme drowsiness
  • Fainting

Does Medicare Cover Oxybutynin?

Original Medicare is unlikely to cover self-administered medications. However, practically all Medicare Part D plans cover oxybutynin. You can confirm whether your plan covers your medication by checking the list of covered drugs (formulary) — you'll usually find oxybutynin within Tier 2. The medication may appear under the brand names Ditropan or Ditropan XL.

How Much Does Oxybutynin Cost With Medicare?

Medicare Part D enrollees must pay for their own medication until they meet their deductible unless they have a deductible-free plan. Providers cannot charge Part D deductibles higher than $480 in 2022, rising to $505 in 2023. 

Oxybutynin costs $45.35 on average for 90 5-milligram tablets, making it a relatively inexpensive drug. However, some pharmacies may charge more or less than this average, so it's worth shopping around to find the best deals. Some people also subscribe to a prescription discount service to obtain vouchers for money off oxybutynin.

Once you've satisfied your deductible, your insurance coverage begins. Many insurers cover the entire cost of oxybutynin without charging enrollees a co-pay when they fill a prescription. However, your insurer may ask you to contribute a modest co-pay, which is unlikely to exceed $1. 

Does Medicare Restrict Coverage for Oxybutynin?

Medicare coverage restrictions for oxybutynin are relatively unusual. Therefore, you're unlikely to need prior authorization from a healthcare provider. Insurers don't typically limit how much oxybutynin you can receive at a time.

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