Does Medicare Cover Spironolactone?
- Spironolactone can treat fluid retention and prevent serious health events if you have hypertension or heart failure. Learn if Medicare covers spironolactone.
Understanding how Medicare coverage for spironolactone works can be helpful if you need to take this medication long-term. This article explains which Medicare policy types cover spironolactone and typical out-of-pocket costs.
What Is Spironolactone?
Your doctor may prescribe spironolactone if you have high blood pressure or heart failure. It's a diuretic medication that lowers your blood pressure to minimize the risk of strokes and heart attacks. Doctors may also prescribe spironolactone for people who have a health condition that causes edema (fluid retention), such as nephrotic syndrome or liver cirrhosis.
Spironolactone reduces salt absorption without negatively affecting your potassium levels. Therefore, your doctor may recommend this medication more highly than other diuretics if you have low potassium levels or have a higher risk of developing a potassium deficiency.
This medication is available in tablet form or as a liquid suspension. It comes in generic versions and under the brand name Aldactone. Most adults take around 75 milligrams of the oral suspension or 100-milligram tablets) per day, but your health care provider may recommend a different spironolactone dosing regimen.
Possible side effects of spironolactone include:
- Bloody, black or clay-colored stools
- Constipation or diarrhea
- Bloody or cloudy urine
- Hives or skin rash
- Nausea or vomiting
- Weight gain
Does Medicare Cover Spironolactone?
All Medicare plans cover spironolactone if they include prescription medication benefits. Therefore, you'll almost certainly receive coverage if you have Medicare Part D. Medicare Part D adds supplementary prescription drug coverage to your existing Original Medicare coverage (Parts A and B.)
Some Medicare Advantage enrollees also qualify for spironolactone coverage. Whether you're eligible hinges on the benefits your plan includes. As Medicare Advantage plans replace Original Medicare, they must offer the same benefits at a minimum. However, many of these plans boast enhanced benefits, which may include prescription coverage.
You won't have coverage for spironolactone if Original Medicare is your only health insurance. Medicare Parts A and B only cover a limited range of doctor-administered medications or drugs requiring durable medical equipment, such as insulin pumps.
How Much Does Spironolactone Cost With Medicare?
Unless you have a deductible-free Medicare Part D or Medicare Advantage plan, you'll pay for your medication until you meet your annual deductible. The upper limit for Medicare Part D deductibles is $480 in 2022 (increasing to $505 in 2023), although many providers set their deductibles substantially lower. Medicare Advantage deductibles depend on your insurance company.
Spironolactone costs between $9 and $24 for 30 25-milligram tablets, although prices may be different at your local pharmacy. After meeting your deductible, your insurance company may offer free coverage because it's such an inexpensive medication. If not, expect your co-pay to be around $1 or less for each prescription.
Medicare Coverage Restrictions for Spironolactone
Medicare coverage restrictions for spironolactone are uncommon. Most Medicare Part D and Medicare Advantage insurers don't impose quantity restrictions or request prior authorization when covering this medication.