Does Medicare Cover Cymbalta (Duloxetine)?

If you manage anxiety, depression or chronic pain caused by a persistent condition, Cymbalta may offer some relief from your uncomfortable symptoms. However, prescription drugs can get expensive. 

Read on to find out what Cymbalta is, whether Medicare can cover this drug and what restrictions may be in place under your insurance plan. 

What Is Cymbalta?

Cymbalta (Duloxetine) is a prescription drug often used to treat depression and anxiety. You can also use it to treat nerve pain associated with diabetes and ongoing pain related to conditions such as fibromyalgia and arthritis. It's classed as a serotonin-norepinephrine reuptake inhibitor, or SNRI, which helps balance the levels of serotonin and norepinephrine in your brain. The result can lower pain, improve sleep, heighten your mood and increase your energy levels. 

It comes in capsules and is taken orally, usually one to two times daily, according to the advice from your doctor. Dosage can vary depending on your age and the severity of your condition. Side effects might include dizziness, nausea, constipation and dry mouth.

Does Medicare Pay for Cymbalta?

If your Medicare plan covers prescription drugs, such as is the case with Medicare Advantage or Medicare Part D, Cymbalta is most likely covered. Cymbalta or its generic equivalent, duloxetine, are usually classed as tier 2 prescription drugs under Medicare Part D, and co-payments are likely to be affordable. It's essential to check your coverage to see whether your plan covers tier 2 prescription drugs. 

Part D coverage can vary in price depending on where you live and the plan carrier. The maximum annual deductible limit is $545, and some plans may even carry a $0 deductible. In addition, the cost of Cymbalta co-payments varies depending on whether you've reached the initial, donut hole or catastrophic coverage stages.

Do Medicare Plans Have Restrictions on Cymbalta?

Some plans include a quantity limit, a restriction on how much of the drug can be filled by your pharmacy at once. There may be a daily limit, meaning you can fill out enough for 30 days, for example. You may find that your insurance isn't able to cover emergency prescription refills if you lose your medication or need a backup supply.