Does Medicare Cover Xyrem?

Christian Worstell
In this article...
  • If you have narcolepsy with cataplexy, your doctor may recommend Xyrem to manage your symptoms. Read on to find out if Medicare covers Zyrem prescriptions.

Xyrem helps manage narcolepsy accompanied by cataplexy, a symptom characterized by a loss of muscle tone while you're awake. When you take this drug, its active ingredient — sodium oxybate — reduces daytime sleepiness and causes fewer episodes of sudden muscle weakness. Keep reading to find out what you can expect if you have Medicare coverage and need to fill a Xyrem prescription.

What Is Xyrem Prescribed For?

Xyrem treats narcolepsy, a condition that causes daytime drowsiness and sudden "sleep attacks." No matter how much you have to accomplish, narcolepsy makes it difficult to stay awake. In some people, it also causes cataplexy, which can interfere with your daily routine.

How Does Xyrem Treat Narcolepsy?

Xyrem helps control narcolepsy symptoms by suppressing the central nervous system (CNS). This type of drug helps you get more deep sleep at night, so you don't get as sleepy during the day.

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Talk to a licensed agent today to find a plan that fits your needs.

Medicare Coverage of Xyrem

Approximately 97% of Medicare prescription drug plans cover Xyrem. Before you fill your prescription, you may need to get prior authorization from Medicare. If your plan requires prior authorization, ask your health care provider to submit a PA form to Medicare on your behalf. Medicare won't cover Xyrem until this form has been approved.

How Much Does Xyrem Cost With Medicare?

How much you pay for Xyrem depends on what Medicare plan you have. You also need to think about whether you're in the deductible stage, the initial coverage stage or the donut hole stage. During the deductible stage, you haven't met your annual deductible. Some plans have $0 deductibles, while others have deductibles of up to $545 per year, so your deductible costs will vary.

Once you satisfy your deductible, you'll enter the initial coverage stage, which is when you pay a co-pay or coinsurance for every prescription. A co-pay is a flat fee (e.g. $20), while coinsurance is a percentage of the cost of the drug. If you're in the donut hole, Medicare limits how much it pays toward each prescription. That means it may cost more to fill your Xyrem prescription. Although Xyrem costs are plan-dependent, all Medicare prescription drug plans have a maximum deductible of $545 per year in 2024.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at

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