Does Medicare Cover Aprepitant?

Chemotherapy causes several side effects, including nausea and vomiting. If you're receiving chemotherapy as part of your cancer treatment, your doctor may prescribe aprepitant to prevent nausea and vomiting during the first few days of each round. Before filling your prescription, it's important to understand whether Medicare covers aprepitant and estimate how much you can expect to pay out of pocket.

What Is Aprepitant Used For?

Aprepitant prevents nausea and vomiting caused by chemotherapy. It's not for treating nausea and vomiting caused by viruses, migraine headaches, gastrointestinal reflux disease or other health conditions. The dosing instructions depend on your treatment schedule, but aprepitant is typically used 1 hour before a chemo session. Aprepitant is most helpful during the first 3 days of each round of chemotherapy, so it's not intended for long-term use.

What Class Is Aprepitant In?

Aprepitant belongs to a class of medications known as antiemetics. It prevents chemo-related nausea and vomiting by blocking the effects of neurokinins in the brain. Neurokinins are the chemicals that make you feel nauseated.

Medicare Coverage of Aprepitant

Original Medicare doesn't cover prescription medications, but enrollees have the option of purchasing Medicare Part D, a prescription drug supplement. Most Medicare Advantage plans also include prescription coverage. Therefore, 99% of Medicare drug plans cover aprepitant. Your healthcare provider may need to request prior authorization before Medicare will pay for aprepitant, but it depends on the terms of your plan.

How Much Does Aprepitant Cost With Medicare?

Although some Medicare prescription drug plans have a $0 deductible, others have deductibles of up to $545, the maximum amount for 2024. If you haven't met your deductible, aprepitant may cost between $40 and $95. Once you meet the deductible, you'll have to pay your prescription co-pay.

Your out-of-pocket costs may change if you enter the coverage gap, which begins once your Medicare drug plan has spent a certain amount of money on your prescriptions. For 2024, the coverage gap begins once your plan has spent $5,030 on covered drugs. When you're out of the coverage gap, you may only have to pay a few dollars for aprepitant.