Does Medicare Cover Sonata?

You're not alone if you regularly struggle to fall or stay asleep. Roughly 35% of American adults experience chronic insomnia at some point in their lives, and the condition can have a significant impact on your health and well-being.

Sonata can help some people with sleep problems, but many worry about the potential costs. So, does Medicare cover Sonata, and how much will you pay out of pocket?

What Is Sonata?

Sonata, also known as zaleplon, is a type of sedative used to treat insomnia. It works by promoting relaxation, which can make it easier to fall asleep and improve the quality of your sleep. 

You should only take Sonata as prescribed by your doctor, usually immediately before going to bed or if you're struggling to fall asleep. The most common adult dosage is 10 milligrams, although your doctor will determine the correct dosage based on your age, health status and other factors. 

Sonata can be habit-forming, and you shouldn't take it for more than 5 weeks unless your doctor instructs you to. It can make you feel sleepy if you take it during the day, so you should only take Sonata when you have adequate time to sleep and abstain from driving or operating machinery. 

Sonata Side Effects

This medication can cause various side effects, including:

• Daytime drowsiness
• Dizziness
• Coordination issues
• Changes in skin sensation, such as numbness or tingling
• Lightheadedness

Does Medicare Cover Sonata?

Around 91% of Medicare prescription drug plans (Medicare Part D) cover Sonata. Therefore, you'll likely have coverage if your Medicare insurance includes Part D. You can find out whether your Medicare plan covers your medication by checking your policy's formulary, which is the list of drugs covered. 

How Much Does Sonata Cost With Medicare?

How much Sonata costs with Medicare coverage depends on whether you've met your deductible. As of 2024, Medicare Part D deductibles cannot exceed $545, although many plans have lower deductibles or no deductibles. Furthermore, your plan may cover certain medications, regardless of whether you've paid your deductible.

You'll usually have to cover the entire cost of your medication until you meet the deductible. Sonata typically appears on Tier 2 of Medicare Plan D formularies. The higher the tier, the more expensive the drug, making Sonata a relatively costly medication. You should expect to pay around $94.29 for 30 10-milligram capsules. 

The Post-Deductible stage begins after you meet your deductible. If your plan covers Sonata, you'll pay a small copay for your medication during the Post-Deductible stage and your insurer will cover the remainder. Copays vary by insurer, but most charge between $1 and $7.

Does Medicare Restrict Sonata Coverage?

Most Medicare Part D plans impose quantity limits on Sonata. This limit restricts how much medication you can receive at a time.