Does Medicare Cover Cabergoline?
- Cabergoline has various clinical uses, and you may be entitled to coverage via Medicare Part D. Learn about Medicare coverage for cabergoline, including co-pays.
If your doctor prescribes cabergoline, you may be wondering how to manage the cost of your treatment. Understanding how Medicare coverage for cabergoline works can provide peace of mind and help you plan your out-of-pocket costs.
What Is Cabergoline?
Cabergoline tablets inhibit prolactin production in the pituitary gland. Doctors prescribe this medication to reduce excessive levels of prolactin in the blood in people with fertility issues, menstrual problems or pituitary gland tumors. Your doctor may also recommend cabergoline if high prolactin levels cause unwanted lactation.
Cabergoline comes in a generic form or under the brand name Dostinex. Most people take between 0.25 milligrams and 1 milligram twice per week, although your doctor will calculate your dose depending on your health condition and prolactin levels. Often, people start on a low dose and gradually increase the dosage until their condition improves.
Occasionally, taking cabergoline can cause problems with your heart, lungs, stomach or kidneys. Seek urgent medical assistance if you experience chest pain, dizziness, severe stomach pain or swelling while taking cabergoline. This medication can also make you feel tired or dizzy, so it's safest to avoid driving if you experience these side effects. Other reported side effects include:
- Changes in skin sensation, such as burning or prickling
- Weight changes
- Feeling generally unwell
- Fast or irregular heartbeat
Does Medicare Cover Cabergoline?
Original Medicare is highly unlikely to cover cabergoline because it only covers medication directly administered by a doctor in limited circumstances. However, Medicare Part D plans purchased through a private provider cover prescription medications, although coverage varies by insurer.
All Medicare Part D plans cover cabergoline in some form. Some plans may cover Dostinex, while others may only cover generic versions. You can find out which cabergoline medications your insurer covers by reading the formulary. Both Dostinex and generic cabergoline typically appear under Tier 2.
How Much Will I Pay for Cabergoline With Medicare Coverage?
Cabergoline is a relatively expensive drug, costing $214.27 on average for eight 0.5-milligram tablets. Enrollees must usually pay for their cabergoline prescription until they meet their annual deductible. As of 2022, Medicare Part D providers cannot charge deductibles higher than $480, which will increase to $503 in 2023.
However, there are some possible exceptions to this rule. Some insurers may agree to cover your prescription before you meet your deductible in specific circumstances. The deductible won't apply if you purchase a more expensive deductible-free policy.
The deductible stage ends once you spend an amount equivalent to your deductible on prescription medications. After that, your insurer will cover the cost minus a co-pay. Co-pays for cabergoline depend on your insurance company. However, you should expect to spend between $2 and $25.
Are There Any Medicare Coverage Restrictions for Cabergoline?
You won't usually need prior authorization for cabergoline coverage through Medicare Part D, and most insurers don't limit how much medication you can receive at a time. However, rules can vary, so it's worth checking your policy's terms.