Does Medicare Cover Nexterone?

In this article...
  • Explore the prescription drug Nexterone, learn how it's used to treat heart arrhythmia and find out whether Medicare covers part or all of the drug costs.

When your heart is beating irregularly, your doctor may need to give you medication, such as Nexterone, to get the situation under control. This drug is only available at a medical facility, so it may come with high costs.

Fortunately, Medicare Part B covers the majority of injectable and infused drugs, as long as they're administered by a licensed medical professional. Nexterone falls into that category — since it's given by infusion by a doctor in a healthcare facility, it usually falls under your Part B coverage. You're still responsible for your Part B deductible and co-pay, but a Medigap plan can help keep costs in check.

Nexterone Drug Information

Nexterone, the brand name for amiodarone HCl, is a prescription drug that's typically used to treat ventricular fibrillation. Your doctor may also prescribe this medication if you have ventricular tachycardia with blood-flow instability and your condition doesn't respond well to other treatments.

Doctors often use Nexterone in emergency situations to slow or stabilize a patient's heart rate; they may also use it for preventative purposes if you have recurring bouts of abnormal heart rhythms. It's an infusion medication, which means it's administered through an IV — usually, a central line. Because it affects your heart and has the potential to cause serious side effects, this medication is always given by medical professionals and followed by constant monitoring.

It's important to note that Nexterone is different from oral amiodarone, which comes in tablet form.

Side effects of Nexterone include low blood pressure, a slowed heart rate, damage to the lungs or a loss of vision. For some people, the medication causes new arrhythmias. Patients may experience damage to the liver that leads to renal failure. Nexterone can cause fetal damage, so it's important to tell your doctor if you're pregnant.

How Much Does Nexterone Cost With Medicare Coverage?

While Medicare Part B usually covers Nexterone, there are associated costs. First, you must pay the deductible, which is $233 in 2022 and $226 in 2023. Once you meet that amount, Medicare pays 80% for services. That means you'll typically need to pay 20% of the costs for Nexterone. This amount varies, but it can't be higher than the current Medicare-approved amount.

Even with Part B coverage, the co-pay for Nexterone may be expensive. A Medigap plan can help cover those costs. Plans A, B, C, D, F, G, M and N cover 100% of your Part B co-pays. Plan K covers 50% of co-pays and Plan L covers 75%. These plans are available through private insurance companies, but the plan benefits are standardized by the federal government. Plan availability may vary by state.

Are There Any Medicare Coverage Restrictions for Nexterone?

Since you can only get Nexterone at a healthcare facility, Medicare prescription drug coverage restrictions don't usually apply. You can't get Nexterone at a pharmacy. If your doctor prescribes amiodarone tablets for follow-up care, you'll likely encounter coverage restrictions.

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