Does Medicare Cover Urso Forte?

In this article...
  • Urso Forte treats biliary cirrhosis and gallstones. This guide explains whether Medicare Part D covers Urso Forte or similar medications containing ursodiol.

If you're experiencing health problems, such as cirrhosis or gallstones, worrying about how to afford essential medication can make your situation more stressful. Fortunately, many people are entitled to prescription drug coverage through their Medicare Part D plans. Below, you can find out whether Medicare covers Urso Forte. 

What Is Urso Forte?

Urso Forte is a brand of ursodiol, a drug used to treat biliary cirrhosis. Your doctor may also prescribe this medication to dissolve gallstones if you don't wish to undergo surgery. Ursodiol works by reducing the cholesterol in bile to prevent it from accumulating to dangerous levels or forming stones. 

Each film-coated Urso Forte tablet contains 500 milligrams of ursodiol. Urso 250 is a similar medication containing 250 milligrams of ursodiol per tablet. 

Typically, you'll need to take Urso Forte two or three times per day with food. However, you should always follow your doctor's dosing advice. Most people need to take Urso Forte for several months before seeing an improvement in their symptoms. 

Potential side effects associated with Urso Forte include:

  • Diarrhea
  • Nausea and vomiting
  • High blood sugar
  • Peptic ulcer
  • Rashes
  • Muscle or joint pain
  • Constipation
  • Hair loss

Does Medicare Cover Urso Forte?

Most Medicare Part D (prescription drug coverage) plans cover Urso Forte. However, it's still worth checking to make sure your policy will cover your medication by consulting your company's formulary. The formulary details what drugs your plan covers, and Urso Forte usually appears under Tier 2.

Ursodiol is covered by 99% of Medicare Part D policies in some form. If your plan doesn't cover the Urso Forte brand, it may cover an alternative, such as Urso 250 or Actigall.

How Much Will I Pay for Urso Forte With Medicare Coverage?

Most Medicare Part D plans include a deductible, which you must pay before your insurer steps in to cover further treatment. However, some companies offer Part D plans with no deductible, although they tend to be more expensive options. Your deductible depends on your policy terms and insurer, but the legal limit for 2022 is $480.

While a few companies may cover certain drugs before you meet the deductible, you'll usually be responsible for paying for your prescription during this period. Prices for Urso Forte vary by pharmacy and area. However, the national average retail price of 60 500-milligram tablets is around $208.73

Your insurer will cover the cost of Urso Forte after you meet the deductible if it's included in your policy's formulary. However, you'll need to pay a modest co-pay every time you claim for an Urso Forte prescription — typically between $1 and $3. 

Are There Medicare Urso Forte Coverage Restrictions?

Medicare Part D insurers don't usually restrict coverage for medically necessary Urso Forte prescriptions. However, different providers have different rules. Some may require your doctor to explain why your medication is medically necessary or restrict how much medication you can receive at a time. 

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