Does Medicare Cover Aprepitant?

Christian Worstell
In this article...
  • Aprepitant prevents nausea and vomiting caused by chemotherapy. Keep reading to learn more about aprepitant and find out whether Medicare covers this drug.

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.

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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.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with HelpAdivsor.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@MyHelpAdvisor.com.

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