Does Medicare Cover Prevacid?

In this article...
  • Prevacid is a proton pump inhibitor that treats conditions caused by excess stomach acid. Discover whether Medicare covers Prevacid and generic alternatives.

If your doctor prescribes Prevacid, you may wonder if your medical insurance can help with the costs. Fortunately, Prevacid is a relatively affordable medication, but long-term use can become expensive. This guide explains whether Medicare covers Prevacid and what you should expect to pay out of pocket. 

What Is Prevacid?

Prevacid is a branded version of the drug lansoprazole, a proton pump inhibitor used to prevent and treat health issues caused by excess stomach acid. These conditions include stomach ulcers and erosive esophagitis. 

You can purchase Prevacid over the counter or get it with a prescription from your health care provider. Always follow the instructions in the package leaflet, or stick to your doctor's dosage guidelines to avoid unwanted effects. 

Most people who use Prevacid take a single capsule daily on an empty stomach, often before breakfast. You can also mix the contents of a Prevacid capsule into apple juice if you struggle to swallow tablets. 

Prevacid can occasionally cause kidney problems. Contact your physician immediately if you notice symptoms of kidney damage, such as reduced urine output or bloody urine. Other potential side effects include:

  • Nausea
  • Stomach pain or discomfort
  • Diarrhea
  • Constipation
  • Headache

Does Medicare Cover Prevacid?

Whether Medicare covers Prevacid depends on your coverage type. Medicare Parts A and B (original Medicare) rarely cover this medication because prescription drugs aren't a covered benefit unless a doctor administers them.  

However, you're likely to qualify for coverage if you have Medicare Part D (prescription drug coverage.) This type of plan supplements regular Medicare coverage, and you can purchase it from a Medicare-approved private insurance company. 

Around 94% of Medicare Part D policies cover lansoprazole medications, although they may not cover the Prevacid brand. Your doctor may agree to prescribe a generic alternative if your insurer excludes Prevacid. Your policy's formulary shows which drugs your insurer covers, and you can usually locate Prevacid and other lansoprazole medications under Tier 2.

How Much Does Prevacid Cost With Medicare?

Enrollees must usually cover their medication costs until they meet their plan's annual deductible, although some plans don't have deductibles or cover certain medications during the deductible stage. The maximum legal Part D deductible is $480 in 2022, increasing to $505 in 2023.

Therefore, you'll likely pay full price for your medication until your spending equals or exceeds your deductible. Prevacid costs around $129.35 for 30 tablets at 30 milligrams each, although prices vary considerably between pharmacies and areas. You may be able to find coupons to reduce medication costs

If covered, your policy begins paying for Prevacid once you've met your deductible. However, you may have to pay a small co-pay each time you fill a prescription. Co-pays for Prevacid and similar medications are usually modest, costing no more than $4. Some insurers waive co-pays for lansoprazole medications altogether. 

Medicare Coverage Restrictions for Prevacid

Medicare Part D coverage restrictions for Prevacid vary by plan and insurer. Most policies don't require prior authorization to cover lansoprazole medications, so you won't usually need verification from your doctor. 

However, your insurer may set quantity limits for Prevacid and similar medications. This restriction controls how much medication your pharmacist can dispense per visit.

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