Does Medicare Cover Zocor?

In this article...
  • Zocor is an inexpensive statin used to treat high cholesterol and reduce the risk of heart attacks and strokes. Discover how Medicare coverage for Zocor works.

Zocor is a relatively affordable drug. However, as most people take this medication long-term, it can make a significant dent in your budget over time. This guide explains everything you need to know about Medicare coverage for Zocor.

What Is Zocor?

Zocor is a type of statin used to reduce the levels of harmful cholesterol in your blood. It's a branded version of simvastatin and is suitable for people aged 10 and older. Your doctor may recommend simvastatin medications, such as Zocor, if you have high cholesterol or are at increased risk of experiencing a heart attack or stroke. 

Most people take a single daily dose of Zocor before bed, and doctors usually recommend taking it with food. You should follow your doctor's dosage instructions closely and continue taking the medication until your clinician tells you it's safe to stop.

Occasionally, Zocor can cause kidney problems. You should seek urgent medical assistance if you notice unusually dark urine, fever or muscle pain. This medication may harm unborn babies, so you should tell your doctor if you're pregnant or intend to conceive while taking Zocor. 

Side effects of Zocor may include:

  • Headache
  • Constipation
  • Nausea
  • Nasal congestion
  • Sneezing
  • Abdominal pain

Does Medicare Cover Zocor?

Medicare Part A and B rarely cover Zocor because they only cover doctor-administered drugs in a clinical setting. However, some Medicare Part D plans (supplemental prescription drug coverage) cover Zocor.

Whether your Medicare Part D plan covers Zocor specifically depends on your insurer's formulary. The formulary provides a list of all prescription drugs covered by your policy. As it's an inexpensive drug, simvastatin medications, such as Zocor, usually come under Tier 1.

If your plan doesn't cover Zocor, it will likely cover a similar alternative. Generic simvastatin is covered by 100% of Medicare Part D policies.

How Much Does Zocor Cost With Medicare?

Your Medicare Part D plan is unlikely to start paying for Zocor until you meet your annual Part D deductible. In 2022, the maximum deductible is $480, rising to $505 in 2023. However, your insurer may charge lower deductibles at its discretion or waive deductibles altogether.

Therefore, enrollees must pay for Zocor out of pocket until they pay the deductible. How much Zocor costs without insurance coverage varies by pharmacy, but it usually retails somewhere between $28 and $100 for 30 20-milligram tablets. Searching for medication coupons could help you save money on the cost of your prescription. 

You'll sometimes pay a small co-pay once you've met your deductible and your coverage kicks in. Co-pays for Zocor are usually $1 or less, but some insurers cover the total cost. 

Are There Medicare Coverage Restrictions for Zocor?

You won't usually need prior authorization from your doctor to obtain coverage for Zocor through your Part D insurer. However, your insurance company may restrict the quantity of medication you can receive each time you visit your pharmacy.

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