Does Medicare Cover Metolazone?

In this article...
  • Discover whether Medicare Part D covers metolazone, a diuretic used to relieve edema in people with heart failure and kidney disease, including average co-pays.

Metolazone is a relatively inexpensive drug, but it can make a significant dent in your budget if you need to take it for a long period of time. Therefore, it's worth understanding whether your Medicare plan covers your medication. Below, we'll explore how Medicare coverage for metolazone works. 

What Is Metolazone?

Metolazone is a diuretic medication that reduces edema (fluid retention and swelling) and controls high blood pressure. Your doctor may prescribe metolazone if you have conditions that cause edema, such as heart failure or kidney problems

Several metolazone medications are available, including generic versions and branded products, such as Mykrox and Zaroxolyn. Most people require one tablet daily, and your doctor may start you on a low dose and increase the amount until you experience appropriate symptom relief. 

Metolazone can cause certain side effects, which may worsen if you consume alcohol. These may include:

  • Dizziness
  • Headache
  • Muscle cramps
  • Sore or swollen joints
  • Constipation or diarrhea

Does Medicare Cover Metolazone?

Roughly 95% of Medicare Part D policies (supplemental prescription drug coverage) cover metolazone in some form. Some plans may only cover generic versions, while others may cover specific brands. 

The simplest way to determine which metolazone medications your policy covers is to check the formulary, a list of covered drugs separated into tiers. The higher the tier, the more expensive the drug. Branded and generic metolazone typically comes under Tier 2. If you can't find the brand prescribed by your doctor, consider asking them if a covered alternative is suitable. 

How Much Does Metolazone Cost With Medicare?

Most Medicare Part D plans include deductibles. Your deductible is the amount of money you must contribute toward your treatment before your coverage kicks in. Therefore, you'll pay for your medication out of pocket until you meet your deductible, which can't be more than $480 in 2022 or $505 in 2023

Fortunately, metolazone is a relatively inexpensive medication, costing around $65.07 for 30 2.5-milligram tablets. Discount coupons can help you purchase your prescription for less. 

Once your insurer begins covering your medication, you'll usually pay a nominal co-pay of $2 or less every time you receive coverage. However, some companies waive co-pays for metolazone altogether. 

Does Medicare Restrict Metolazone Coverage?

Your Medicare Part D plan is unlikely to restrict coverage for metolazone. Therefore, your insurer won't usually ask for a doctor's authorization or limit how much medication your pharmacist can fill per visit.

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