Does Medicare Cover Sertraline?

Having prescription drug coverage via your Medicare plan can help ease financial pressure if you're diagnosed with a mental health condition. Let's explore how Medicare coverage for sertraline works. 

What Is Sertraline?

Sertraline is a selective serotonin reuptake inhibitor (SSRI) medication used to treat several mental health conditions, including depression, obsessive-compulsive disorder (OCD) and anxiety. It eases symptoms by elevating levels of a mood-balancing chemical called serotonin in your brain.

Doctors often prescribe a branded version of sertraline called Zoloft. Sertraline is available in both tablet form and a concentrated liquid to mix with water and swallow. Healthcare providers may recommend starting on a low dose and increasing the amount you take until you achieve adequate relief. However, it can take a few weeks before you notice significant improvements. 

Sertraline isn't usually habit-forming, but it could cause withdrawal symptoms if you stop taking it suddenly. Your doctor may tell you to gradually reduce the amount you take if you no longer wish to use sertraline, even if you're symptom-free. 

Sertraline Side Effects

Sertraline sometimes causes side effects, which may include:

• Nausea or vomiting
• Constipation or diarrhea
• Tiredness
• Headache
• Insomnia
• Appetite and weight changes
• Sexual problems

Does Medicare Cover Sertraline?

You'll almost certainly have sertraline coverage if you're a Medicare Part D enrollee or have a Medicare Advantage policy with prescription medication benefits. All Part D plans cover sertraline, although it's unclear how many cover Zoloft and other branded versions. 

Regular Medicare (Parts A and B) doesn't cover prescription medications unless they're professionally administered or administered using durable medical equipment (DME). Neither of these exceptions is likely to apply to sertraline. Therefore, it could be worth considering purchasing supplementary prescription drug coverage (Medicare Part D) from a private insurer if you only have Parts A and B.

How Much Does Sertraline Cost With and Without Medicare Coverage?

Generic sertraline costs between $9 and $89 for 30 100-milligram tablets without Medicare coverage. However, these prices may not apply to branded sertraline. As prices for sertraline are relatively variable, you could save a considerable amount on your prescriptions by shopping around. 

If your Medicare plan covers sertraline, you must usually meet your deductible before your insurance company starts paying out. Part D deductibles must not exceed $545 in 2024 (up from $505 in 2023) and Medicare Advantage deductibles can be substantially more expensive. Although there are deductible-free options available, they usually command much higher monthly premiums. 

Your insurer may waive co-pays for sertraline after you meet your deductible. However, many charge co-pays of up to around $1. 

Sertraline Coverage Restrictions With Medicare

You won't usually need prior authorization from your doctor before your Part D or Medicare Advantage provider agrees to cover sertraline. However, many companies have quantity limits, which means that you can only receive a pre-agreed amount of your medication each time you visit your pharmacy.