Does Medicare Cover Myrbetriq?

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  • Does Medicare cover Myrbetriq? Learn about the cost of medications for overactive bladder so you can make informed decisions about your treatment plans.

Roughly 33 million Americans suffer from overactive bladder (OAB), according to the National Association for Continence. If your doctor has diagnosed you with the condition, frequent trips to the bathroom and worries about wetting accidents may get in the way of your daily activities. A prescription drug called Myrbetriq can help treat OAB and is often covered by Medicare, making it more affordable to get relief from your symptoms.

Does Medicare Cover Myrbetriq?

GoodRx reports that 100% of surveyed Medicare prescription plans include coverage for Myrbetriq. You'll need to consult your Medicare Part D plan or the prescription coverage portion of your Medicare Advantage plan to double-check that you're covered.

What Does Myrbetriq Do?

Myrbetriq is a prescription drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of urinary urgency, frequent urination and urine leakage due to OAB. Ordinarily, you get the urge to go to the bathroom when your bladder fills up with urine, causing the muscles of the organ to contract. If you have OAB, muscle contractions occur before the bladder is full. Myrbetriq works by relaxing the bladder muscles to reduce symptoms of overactive bladder.

How Much Does Myrbetriq Cost?

The average retail price for a 30-day supply of Myrbetriq 50 mg as of October 2021 is around $500, according to GoodRx. You could pay may or less for the drug depending on where you live and fill your prescriptions.

Is There a Generic for Myrbetriq 50 mg?

The generic name for Myrbetriq is mirabegron. As of October 2021, the FDA hasn't approved a generic version of the drug.

When Will Medicare Pay for Myrbetriq?

If Myrbetriq is included in your Medicare prescription drug plan's formulary, your policy is likely to cover the medication, provided you:

  • Have an established medical need for Myrbetriq
  • Obtain a prescription from a doctor who participates in Medicare
  • Continue to pay your Medicare premiums
  • Cover any coinsurance or copays that you are responsible for under the terms of your plan

How Much Will I Pay for Myrbetriq With Medicare?

With Medicare Part D, drug pricing is based on the tier of the drug and your stage of coverage. Each Medicare prescription plan establishes a formulary that uses four tiers.

The lower the tier, the less you'll usually pay out of pocket. Myrbetriq is usually considered a Tier 3 or Tier 4 drug because it doesn't have a generic equivalent.

Medicare Part D plans have four stages of coverage. The amount of the cost of Myrbetriq that you'll be responsible for depends on the stage. Here's a rundown on how coverage affects what you'll pay for the drug.

  • Deductible stage. Before you have paid the deductible specified by your plan, you'll usually have to cover all of the cost of Myrbetriq yourself.
  • Post-deductible stage. Once you have met the deductible, your Medicare drug plan will likely pay for most or some of the drug, and you’ll be responsible for a copay or coinsurance.
  • Coverage gap stage. Once the combined amount that you and your plan have spent on drugs reaches a certain level, you enter the coverage gap or donut hole and typically must pay 25% of the cost of Myrbetriq.
  • Catastrophic coverage stage. If your combined drug spending reaches the catastrophic coverage level, your Medicare plan generally begins paying for most of the cost of Myrbetriq, and you pay only a copay or coinsurance.

How Can I Get Help Paying for Myrbetriq?

The manufacturer of Myrbetriq offers programs to make the drug more affordable; however, the terms generally exclude people who are covered by Medicare. Some states offer Pharmaceutical Assistance Programs for people on Medicare.

What Is an Alternative to Myrbetriq?

The Mayo Clinic lists the following drugs as approved treatments for overactive bladder:

  • Darifenacin
  • Fesoterodine
  • Oxybutynin
  • Solifenacin
  • Tolterodine
  • Trospium

Other potential treatments for OAB include:

  • Behavioral therapies like biofeedback and pelvic floor exercises
  • Botox injections
  • Nerve stimulation procedures
  • Surgery to increase bladder size
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