Does Medicare Cover Plaquenil?
- Taking a long-term medication like Plaquenil can become expensive. Read about Medicare coverage for Plaquenil, including an out-of-pocket cost outline.
If your doctor prescribes Plaquenil to treat an autoimmune condition, you'll likely have to take your medication for an extended period of time. It's essential to consider how to pay for your ongoing treatment and whether your health insurance can help. This article explains whether Medicare covers Plaquenil and how to determine your coverage.
What Is Plaquenil?
Plaquenil is a branded version of hydroxychloroquine. Hydroxychloroquine is a type of disease-modifying anti-rheumatic drug (DMARD) used to reduce the risk of joint damage in people with arthritis. Your healthcare provider may recommend taking Plaquenil if you have lupus, rheumatoid arthritis or another type of inflammatory arthritis caused by an autoimmune disease.
The most common Plaquenil dosing regime is 5 milligrams per kilogram of body weight, up to a maximum daily dose of 400 milligrams. However, your doctor may prescribe a higher dosage if your condition is severe.
Plaquenil Side Effects
Most people take Plaquenil with a meal because food can reduce the risk of side effects, especially if you eat something containing fat. These side effects may include:
- Hair loss
- Dark patches on the skin
- Vision problems
- Muscle weakness
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Does Medicare Cover Plaquenil?
Medicare won't usually cover Plaquenil unless you have supplemental prescription drug coverage (Medicare Part D). Original Medicare doesn't typically pay for self-administered medications, although it does cover a small number of drugs when administered by a healthcare provider.
Medicare Part D policies are available through private insurance companies for a monthly premium. All Medicare Part D plans cover Plaquenil or generic hydroxychloroquine. Your doctor may prescribe an alternative medication containing the same drugs if your policy excludes the Plaquenil brand.
You can check which hydroxychloroquine versions your policy covers by reading your insurer's formulary (covered drugs list). Plaquenil and similar alternatives are mid-priced medications and usually classify as Tier 2 drugs.
How Much Does Plaquenil Cost With Medicare?
If your policy covers Plaquenil, you'll likely need to pay your annual deductible before your plan begins paying for your prescriptions. The average Part D deductible is around $367, although insurers can set deductibles up to the legal limit of $545 (increasing to $505 in 2023). Some companies offer $0 deductibles in return for a higher monthly premium.
You'll pay for your prescriptions at the same rate as you would without insurance until you've spent enough to cover your deductible. The average retail price of Plaquenil is approximately $123.11 for 60 tablets at 200 milligrams each, although costs vary, depending on your pharmacy and where you live. Consider searching for discount vouchers to reduce the cost of Plaquenil.
The post-deductible stage begins after meeting your deductible. Your insurance company covers the cost of your prescriptions during the post-deductible phase, although some impose co-pays when you receive coverage. Co-pays for Plaquenil rarely exceed $2.
Are There Any Medicare Coverage Restrictions for Plaquenil?
Most Medicare enrollees receive unrestricted coverage for medically necessary hydroxychloroquine medications, such as Plaquenil. Therefore, insurers don't usually limit how much medication you can receive at a time or ask for prior authorization from a healthcare provider.