Celebrex (Celecoxib) Prescription and Medicare Coverage

In this article...
  • Finding a Medicare plan option that covers your medication is crucial. Learn more about what Celebrex is and how to cover your prescription drug needs.

Celebrex is a medication commonly prescribed to treat symptoms of pain and arthritis, including joint pain, inflammation, swelling and stiffness. It comes as an oral capsule, and you have the option to purchase either the brand name or the generic drug version. Drugs can be expensive if you don't have the right insurance coverage to help you cover the cost, even though medications are often needed for a better quality of life.

Let's take a more detailed look at what Celebrex is and what Medicare options are available to help make it more accessible. 

What Does Celebrex Do?

Celebrex contains the active ingredient celecoxib and is categorized as a nonsteroidal anti-inflammatory (NSAID) medication. It can be prescribed to treat a variety of issues such as juvenile arthritis, osteoarthritis, ankylosing spondylitis and pain due to menstruation or rheumatoid arthritis. The prescribed dosage is typically set to 200 mg and should be taken one to two times daily. It can be taken with or without food, but you should try to take it with a full glass of water.

The way the medication works is that it inhibits the
inflammation-causing chemicals in your body known as prostaglandins to reduce substances that cause symptoms of pain and inflammation. As helpful as the drug can be, there are also a few common side effects that can be experienced from taking it. These side effects can include:

  • Headache
  • Constipation
  • Upset stomach
  • Diarrhea
  • Vomiting
  • Heartburn
  • Gas
  • Dizziness
  • Nose or throat irritation

Celebrex can also increase the risk of a heart attack or stroke as well as stomach ulcers and bleeding. The risk is higher in older people and those who have had stomach problems before.

There are
ways to treat the side effects to prevent them from causing any long-lasting damage. If side effects persist for too long, it's best to stop taking the drug completely and to call your doctor.

Medicare Coverage for Celebrex or Celecoxib

It's possible some Medicare plans do not provide coverage for Celebrex, but there are some Medicare Advantage plans or Medicare Part D plans that may cover the generic brand of celecoxib. While not all plans are the same, each option offers something unique for prescription drugs whether it be the best price, best quality or best customer service. 

Medicare Advantage plans that offer coverage for prescription drugs are known as Medicare Advantage Prescription Drug Plans (Ma-PD). These plans usually have their own formulary, or drug lists, that give details on which drugs are covered by the plan and how they are covered. Celecoxib is usually listed as
Tier 2 on Medicare prescription drug plans. Most plans have a total of five tiers that determine how much the prescription drug might cost you. Drugs that are listed in higher tiers usually cost more than the ones listed in lower tiers. 

Drug coverage and availability for celecoxib varies depending on which plan you have. You can try finding
Medicare Advantage plan options in your area that will cover your prescription drug needs. 

Average Costs for Celebrex Based on Medicare Prescription Coverage

Your coverage stage and Medicare plan option are the factors that determine the cost for any copay or deductible that you'll pay. There are two possible coverage stages that you can be in that affect how much you may have to pay for Celebrex. 

Deductible Stage

Your deductible is the amount of money you have to pay out-of-pocket for covered prescription drugs to become eligible for coverage by your Medicare plan. While in the deductible stage, you're responsible to pay for the full cost of the drug. It is possible to find Medicare drug plans that have a $0 deductible. In 2022, Medicare drug plans can't have a deductible that's greater than $480. 

Copay Stage

To enter the initial coverage period, you have to meet your Part D deductible first. Anytime you purchase prescribed medication beyond that point, you typically pay the copayment, which is a flat fee determined by your insurance plan. If there is no copayment, you most likely have a coinsurance plan, which means you pay a set percentage of what the total cost is for your medication.

You can find the total cost of the deductible or copay that you're responsible for by learning more about your plan or contacting your insurance provider. 

Important Information To Better Understand Celebrex

Is Celebrex Stronger Than Ibuprofen?

There have been numerous studies conducted to compare the effects that Celebrex and ibuprofen both have on pain. The answer ultimately depends on what type of pain you're experiencing. They are both classified as NSAIDs and come with their own sets of benefits and side effects. 

Does Celebrex Make You Sleepy?

There are many side effects that come with taking Celebrex, but the oral capsule does not typically cause drowsiness. It should be safe for you to take in the morning or during the day without worrying about becoming drowsy. 

Is Celebrex a High-Risk Medication?

Although doctors have been reluctant to provide celecoxib in the past because of safety concerns, the Food and Drug Administration (FDA) voted 15-5 in 2018 that the drug poses no greater risk for causing heart attacks and strokes than other widely used painkillers. Following proper dosages and the instructions of your doctor are both important techniques for taking medication safely.

Celebrex has benefits and drawbacks like any other prescription drug out on the market and can be affordable based on which Medicare plan you have. Having a conversation with your doctor may be a good way to determine whether the medication is right for you.  

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