Does Medicare Cover Topamax?

In this article...
  • Topamax is a branded anticonvulsant medication used to treat seizures in people with epilepsy. Explore how Medicare coverage for Topamax and topiramate works.

If you need to take anticonvulsant medication long-term, having the right prescription drug insurance can help reduce the impact on your wallet. This guide explores Medicare coverage for Topamax and other topiramate medications. 

What Is Topamax?

Topamax is a branded version of the generic medication topiramate. Doctors sometimes prescribe topiramate medications to reduce or prevent epileptic seizures in adults and children. It's also used to prevent migraines.

Topiramate is an anticonvulsant drug. It works by reducing abnormal brain activity to minimize the risk of tonic-clonic and partial-onset seizures. This medication comes in the form of tablets, sprinkle capsules and liquids and is available in generic forms. Branded versions include Topamax and the following:

  • Eprontia
  • Qudexy XR
  • Trokendi XR

Most people take one or two doses of Topamax each day with or without food. Your doctor may tell you to take your medication at the same time each day to improve its efficacy and reduce the risk of side effects. 

This medication can harm unborn babies, so your doctor may recommend using contraception when taking Topamax and changing to a different medication during pregnancy. Occasionally, this medication can cause mental health problems, which may include suicidal thoughts. Other possible side effects include:

  • Numb or tingling hands and feet
  • Weight loss
  • Acid reflux
  • Nosebleeds
  • Changes in the menstrual cycle
  • Uncontrollable shaking or eye movements
  • Headache
  • Weakness

Does Medicare Cover Topamax?

Original Medicare (Parts A and B) doesn't usually cover Topamax. However, you may have coverage if you're a Medicare Part D enrollee or have a Medicare Advantage plan with prescription drug coverage. 

All Part D plans cover generic topiramate, although it's unclear how many plans pay for the Topamax brand. Your policy's formulary (covered medication list) can tell you which topiramate drugs your insurer covers. Medications containing topiramate generally fall under Tier 1.

Coverage for Topamax is usually unrestricted. Therefore, most insurers don't require prior authorization or set quantity restrictions for this medication.

How Much Does Topamax Cost With Medicare?

Original Medicare enrollees must pay for Topamax out of pocket unless they also have supplemental Part D coverage. People with Medicare Part D or Medicare Advantage coverage pay for their medications until they satisfy their deductibles unless they have a deductible-free plan. 

Topamax costs vary greatly depending on where you live and the pharmacy you use. In some areas, the cost of 30 25-milligram pills may range between $9 and $139. As the retail price range for Topamax is relatively wide, it could be worth shopping around to find the most affordable option. You could also try searching for discount vouchers to reduce the cost of Topamax. 

Some insurance companies cover the entire cost of Topamax prescriptions once you've met your deductible. If your insurer charges co-pays, they're usually nominal. Topamax co-pays are usually $1 or less. 

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