Does Medicare Cover Avodart

Avodart is a prescription medication used to treat men with benign prostatic hyperplasia (BPH), also known as an enlarged prostate gland. This drug is relatively expensive, so Medicare beneficiaries may wonder if their plan will help cover the cost.

Generally, Medicare prescription drug plans don’t offer coverage for Avodart. But the generic version of Avodart, dutasteride, is covered by 96% of Medicare prescription drug plans. Generic versions of drugs are required to have the same active ingredients, safety and effectiveness as their brand-name counterparts. To find out if your plan covers Avodart or dutasteride, check the formulary.

What Is Avodart Used For?

Avodart and its generic versions are both used to treat men with enlarged prostates. The drug helps shrink the prostate. It does this by blocking an enzyme that causes the prostate to become enlarged. This effect only lasts as long as men keep taking the drug; when Avodart is discontinued, the enzyme is no longer blocked and the prostate can continue growing.

Avodart comes in pill form. These pills are taken whole, with or without food, per your doctor’s directions. The prescribed dose may vary from one person to another, depending on their health needs.

Are Flomax and Avodart the Same?

No. Flomax (tamsulosin) is another prescription drug used to treat men with benign enlargement of the prostate. It may be prescribed alongside Avodart. Flomax doesn’t shrink the prostate, but it can help provide relief from problems in urinating. As with Avodart, Medicare plans may not cover brand-name Flomax, but most cover the generic version.

How Much Does Avodart Cost With Medicare?

Without insurance, Avodart is a relatively expensive drug. The average retail price of brand-name Avodart is $283.73 for 30 capsules. The same quantity of the generic dutasteride averages $147.73. Medicare plans may help make these drugs more affordable.

Some Medicare plans may offer coverage for the brand-name drug, while most offer coverage for the generic version of Avodart. Check your plan’s formulary to see if it covers Avodart or the generic. In either case, your specific out-of-pocket costs may be affected by your plan’s deductibles and co-pays.

The deductible is the amount you pay out of pocket before your plan starts covering costs. Deductibles may vary from one plan to another, but by law, can’t be more than $545 in 2024 and $505 in 2023. Until you meet your deductible, you’ll pay for the full cost of Avodart and other prescription medications out of pocket.

After meeting your deductible, co-pays apply for covered medications. Drug plans generally have 5 tiers of coverage, and drugs on higher tiers have higher co-pays. Plans generally place the generic dutasteride on Tier 2, meaning the co-pays are relatively low. Depending on the plan, this co-pay could be a flat fee, such as $10 or $20, or a percentage of the drug’s cost, such as 15%.