Does Medicare Cover Belsomra?

In this article...
  • Find out whether or not Medicare covers the cost of Belsomra, a prescription medication used to treat insomnia. Explore other ways to pay for Belsomra.

The U.S. Centers for Disease and Prevention reports that 35.2% of all adults in the United States fail to get the recommended minimum 7 hours of sleep every night. In 2014, the U.S. Food and Drug Administration approved Belsomra as a treatment for insomnia or a lack of sleep. If your doctor has prescribed Belsomra, you may worry about how you'll pay for the drug. Read on to learn about the costs of Belsomra and whether Medicare will pay for the medication.

What Is Belsomra?

Belsomra is a medication approved to treat insomnia in adults aged 18 and over. Studies have shown that people who took Belsomra fell asleep more quickly and stayed asleep for longer than those who were treated with a placebo. Scientists believe that Belsomra works by interfering with the actions of a natural brain chemical called orexin. This neurotransmitter sends signals to the brain that wake up your body.

Is There a Generic Version of Belsomra?

The generic name for Belsomra is suvorexant. As of September 2021, no generic form of the drug has been approved for sale in the United States.

What Are the Side Effects of Belsomra?

Merck reports that roughly 7% of study participants experienced next-day drowsiness after taking Belsomra. Additionally, Belsomra may cause:

  • Abnormal dreams
  • Decreased alertness
  • Worsening symptoms of depression
  • Complex sleep behaviors like eating, walking or driving while asleep
  • Sleep paralysis, a temporary inability to move or talk
  • Temporary weakness of the legs

Your doctor will determine whether the risks of side effects associated with the drug outweigh its potential benefits.

What Is the Price of a 30-Day Supply of Belsomra?

The price for a 30-day supply of Belsomra varies based on where you live and fill your prescriptions. For people without any type of insurance coverage, the average cost of a 30-day supply is approximately $410.40. The average price per pill is $13.68.

Does Medicare Pay for Belsomra?

Medicare Part D plans can determine which drugs they provide coverage for. GoodRx estimates that roughly 42% of Medicare drug plans cover Belsomra.

Do Medicare Advantage Prescription Drug Plans Pay for Belsomra?

Medicare Advantage plans that have a prescription component may cover all or some of the cost of Belsomra. Insurers can choose which insomnia drugs their plans cover, so yours may or may not pay for Belsomra.

Is Belsomra a Tier 3 Drug?

Medicare prescription plans classify drugs into tiers to determine out-of-pocket pricing. Belsomra will fall under Tier 3 or 4, which are reserved for drugs that don't have generic equivalents.

Drug plans have the right to classify certain medications as preferred. These medications incur lower out-of-pocket costs than non-preferred drugs. Which tier includes Belsomra depends on the criteria for the system used by your plan and whether the plan considers the drug a preferred medication.

What Is the Price of Belsomra With Medicare?

How much Belsomra costs for those who have Medicare prescription drug plans that cover the medication varies through each stage of coverage.

  • Deductible stage. Until you have met your plan's deductible, you may be responsible for paying up to the full price of the drug.
  • Post-deductible stage. Once you have paid the deductible, you will likely need to pay a copay. Copay rates may be as little as $3 to over $400, depending on your plan's terms.
  • Coverage gap. When you reach the coverage gap, you may have to pay for all or some of the cost of the medication out of pocket.
  • After the coverage gap. Once you reach the catastrophic coverage stage after the donut hole, your Medicare plan should pay for most, if not all, of the cost of Belsomra.

How Can I Find Out If My Medicare Plan Covers Belsomra?

The best way to determine if your Medicare plan pays for Belsomra is to contact them directly. Many plans offer an online tool that lets you quickly check the coverage for specific drugs.

What If I Can't Afford Belsomra?

Through the Merck Helps Patient Assistance program, the manufacturer of Belsomra provides financial assistance for individuals who can't afford Belsomra. To qualify you must:

  • Be a resident of the United States
  • Have received a prescription for Belsomra from a doctor or other licensed prescriber in the United States
  • Prove that your Medicare plan will not pay for the drug and that you are ineligible for other assistance programs
  • Show demonstrated financial need