Does Medicare Cover Arimidex?

In this article...
  • Arimidex is a prescription drug used to slow the growth of breast cancer tumors. Learn how Medicare coverage for Arimidex works, including how much it costs.

Breast cancer is the second-most common type of cancer diagnosed in American women, after skin cancer. The American Cancer Society estimated that in 2022 alone, about 287,850 new breast cancer diagnoses would be made, and about 43,250 women would lose their lives to the disease.

To treat breast cancer, doctors may prescribe a variety of medications, including Arimidex. If your doctor has recommended Arimidex, you may wonder why it’s used and if your Medicare plan will pay for it.

What Is Arimidex Used For?

Anastrozole, sold under the brand name Arimidex, is a prescription drug that’s used to treat breast cancer in postmenopausal women. It works by reducing the amount of estrogen in the body. Since many types of breast cancers use estrogen to grow, this can help slow the growth of the tumor.

Arimidex and generic versions of the drug come in tablet form. The typical dose is one 1-milligram tablet per day, although your doctor may recommend a different amount. Regular check-ups and blood tests may be needed while taking this medication to watch for side effects, such as high cholesterol.

Does Medicare Cover Arimidex?

Brand-name Arimidex is a very expensive drug. It typically costs $1,886.51 for 30 tablets. In contrast, a 30-tablet supply of the generic version, anastrozole, costs an average of $109.44. Medicare beneficiaries may wonder if their prescription drug plan could help cover these costs.

Generally, Medicare plans don’t cover Arimidex, but 100% of Medicare prescription drug plans offer coverage for the more affordable generic version. You can find out if your plan covers Arimidex or the generic version by checking the plan formulary. The formulary is the list of covered drugs.

While Medicare plans don’t typically cover Arimidex, there are other ways for beneficiaries to access this brand-name drug. As of 2022, ANI Pharmaceuticals has a patient assistance program to help women with breast cancer, including Medicare beneficiaries, access Arimidex. The program provides a 30-day supply of Arimidex for $60, or a 90-day supply for $180.

How Much Does Arimidex Cost With Medicare?

The cost of Arimidex/anastrozole could vary from one Medicare prescription drug plan to another. The major factors affecting your out-of-pocket costs are your plan’s deductible, co-pays and drug tier system.

Most drug plans have an annual deductible. In 2022, this deductible can be as high as $480. This is the amount you need to pay for your prescription medications before your plan kicks in. You're responsible for the full retail price of your medications until you meet your deductible.

Co-pays are a cost-sharing requirement that begin after you meet your deductible. They could be expressed as a flat dollar amount you pay for each prescription or as a percentage of the cost of the drug.

The specific co-pay for a drug depends on what tier it occupies on the formulary. Tiers can vary, but in plans with a five-tier formulary, tier 1 refers to drugs with the lowest co-pays, while tier 5 refers to specialty drugs with the highest co-pays. Generally, anastrozole is classified as a tier 1 drug. Some plans cover tier 1 drugs at a $0 co-pay, while others may charge a nominal fee. Check your plan’s formulary for pricing details.

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