Does Medicare Cover Somavert?

In this article...
  • Medicare plans offer coverage for Somavert, but prior authorization and co-pays are usually required. Learn more about this medication and related costs.

Somavert is an expensive medication, and it can be difficult to obtain. However, it's one of the few treatments for acromegaly. Keep reading to learn more about this medication and how Medicare coverage for Somavert works.

What Is Somavert? 

Somavert is a prescription growth hormone receptor antagonist used to treat acromegaly, a condition that causes your body to produce too much growth hormone. Acromegaly can cause abnormal growth of bones, organs and other tissue. This condition occurs in adults, often around middle age, and the abnormal growth can lead to cosmetic concerns and serious health problems. 

People who take Somavert inject a small amount of the medication under their skin each day. The medication typically comes in a powder form and must be mixed into a liquid before injection. Doctors may prescribe Somavert if other treatment methods, such as surgery or radiation therapy, don't work. 

Does Medicare Cover Somavert? 

Somavert is covered by 100% of Medicare Part D and Medicare Advantage plans. However, the drug can still be expensive due to deductibles and co-pays.

Most plans require prior authorization before covering Somavert. Your doctor must submit a prior authorization request, and the insurer must approve the prescription before a beneficiary has any coverage. 

How Much Does Somavert Cost With Medicare? 

Although Medicare plans cover Somavert, it's considered a tier 5 drug, the most expensive medication category. Most plans require beneficiaries to pay between $400 and $600 for the medication until they meet their deductible. Even after the deductible, some Medicare plans require co-pays of up to $525 per month.

Medicare beneficiaries may enter catastrophic coverage after they've paid a certain amount of out-of-pocket expenses in a year. For 2023 that amount is $7,400. This coverage is sometimes called post-donut hole coverage. Beneficiaries who have met these limits can expect lower co-pays between $7 and $28. 

Are There Other Ways to Get Somavert? 

Although Medicare co-pays for this medication may seem high, the regular retail price for a 30-day supply of Somavert is around $7,550. Retail pharmacies don't typically stock this drug, so people who need it must order from a specialty pharmacy. Unfortunately, there aren't cheaper or generic versions of this medication. However, Pfizer, the manufacturer of the drug, offers a discount program to those who qualify.

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