Does Medicare Cover Lidocaine Patches?

Lidocaine patches are a non-addictive treatment for several painful conditions, and many people find that they provide effective pain relief. The patches are applied directly to the skin to reduce discomfort. 

If your doctor recommends lidocaine patches for your medical condition, you may be wondering how to fund your treatment. So, does Medicare cover lidocaine patches? Below, you can find out which Medicare plans cover lidocaine patches and how the treatment works. 

Does Medicare Cover Lidocaine Patches?

Original Medicare (Parts A and B) doesn't cover prescription drugs such as lidocaine patches. However, you may be covered for lidocaine patches if you have Medicare Part D insurance. Part D insurance is also known as a drug plan, and you can purchase a policy through a Medicare-approved private insurer. 

Whether your Medicare Part D policy covers lidocaine patches depends on if it's on the insurer's formulary, which is a list of drugs that the private company covers. Drugs are divided into categories, and Part D plans must cover at least two drugs from each category. This means that most beneficiaries should be able to get coverage for a similar drug if their chosen drug or brand isn't covered. 

Medicare Part D plans only cover drugs that are medically necessary, and they don't usually cover off-label use. In other words, you can usually only receive funding for lidocaine patches if you need them for FDA-approved use. 

However, Medicare Part D providers may make exceptions if your doctor provides a compelling medical reason for them to do so. For example, your provider may agree to cover drugs not included in its formulary or for off-label use if your doctor reasonably believes that it is the best possible treatment for your condition and no other treatment could produce satisfactory results. 

Does Medicare Advantage Cover Lidocaine Patches?

Some Medicare Advantage (Part C) Plans or Medicare Health Plans include Part D coverage, allowing beneficiaries access to funding for medically necessary drugs. Whether your Medicare Advantage or Health Plan covers lidocaine patches depends on if the drug appears on its formulary. As with a separate Part D policy, your physician may be able to argue for an exception if your plan doesn't cover lidocaine patches but they're the best treatment for your needs. 

What Diagnoses Will Cover Lidocaine Patches?

Medicare will usually only consider covering lidocaine patches for FDA-approved use. The FDA approves lidocaine patches to treat the pain caused by shingles (post herpetic neuralgia). It also approves the drug for pain caused by nerve damage in people with diabetes (diabetic neuropathy). 

However, lidocaine patches have several common off-label uses, such as to treat osteoarthritis and degenerative disc disease pain. Medicare Part D doesn't usually cover lidocaine patches to treat these conditions apart from in exceptional circumstances. 

How Do Lidocaine Patches Work?

Lidocaine patches contain a local anesthetic that disrupts pain signals to the brain to relieve discomfort. The skin gradually absorbs the medication. The treatment is usually used for burning, aching or stabbing pains caused by nerve damage or irritation, commonly due to shingles. Lidocaine patches are non-addictive, making them a safer alternative to opioid-based painkillers.

You can apply lidocaine patches directly to the affected area up to three times a day, usually for no longer than 12 out of every 24 hours. The treatment is only suitable for intact skin, and you should clean and dry your skin thoroughly before applying each patch. 

Lidocaine patches are available on prescription at a 5% dosage or over the counter as a 4% patch. You should use lidocaine patches exactly as directed by your doctor or pharmacist, or according to the instruction leaflet if you're using non-prescription patches. Using lidocaine patches more often or for longer than medically recommended can increase the chances of side effects. 

Who Shouldn't Use Lidocaine Patches?

Lidocaine patches are unsuitable for people with certain medical conditions and may interact with other drugs. You should ensure that your doctor or pharmacist is aware of any preexisting health conditions and inform them if you're pregnant, taking other medications (including over-the-counter drugs like Tylenol) or allergic to any other drugs. You should also inform your doctor if you have surgery planned because lidocaine patches can interact with other anesthetics. 

Do Lidocaine Patches Have Side Effects?

Lidocaine patches sometimes cause itching, burning, redness and swelling at the application site. If you experience these symptoms, take the patch off and wait until your symptoms go away before applying another patch. If your symptoms are severe, you should seek medical attention as soon as possible. 

Lidocaine patches occasionally cause more serious side effects, such as hives or blisters, breathing difficulties, facial swelling and vomiting. These side effects are rare and require urgent medical assessment.

Using lidocaine patches for longer than prescribed or wearing multiple patches at once can cause an overdose. If you're concerned that you're experiencing a lidocaine overdose, you should call the poison control helpline at 1-800-222-1222 or 911 if you're experiencing serious symptoms such as breathing problems.