Does Medicare Offer Prescription Drug Coverage for Duloxetine?

If you take a medication like duloxetine, it's important to find a Medicare plan with adequate prescription drug coverage. Prescription prices can add up quickly, so the right type of insurance can defray costs and help you manage healthcare expenses. Before you choose Original Medicare or a Medicare Advantage plan, make sure to get an estimate of how much you'll pay for each refill of your duloxetine prescription.

What Is Duloxetine?

Duloxetine is a prescription drug that's part of the selective serotonin and norepinephrine reuptake inhibitor (SNRI) family. When you take it, the active ingredients help prevent your brain from reabsorbing the norepinephrine and serotonin in your system. This increases the levels of both substances in your body, which can help improve your mood and reduce the effect of pain signals.

Duloxetine is the generic name for the medication; some brands may give it a different name. In the United States, the Food and Drug Administration (FDA) allows select companies to offer duloxetine. The most recognizable option is Cymbalta. Sun Pharma also makes delayed-release duloxetine capsules called Drizalma Sprinkle, but they are on hold until the brand completes the FDA's required assessment for nitrosamine impurities.

What Conditions Does Duloxetine Treat?

As an SNRI, duloxetine is typically prescribed to treat two main concerns: mood disorders and pain. Since it's formulated to improve your mood, your doctor may prescribe the drug to alleviate the effects of depression or anxiety.

In some cases, the drug can also be used for conditions that cause chronic pain. Doctors may prescribe it to relieve certain symptoms of diabetes, including discomfort that can result from nerve damage. You may also take duloxetine for a range of additional conditions, including fibromyalgia, osteoarthritis or other types of muscle and bone discomfort.

Does Medicare Cover Duloxetine?

Most Medicare Part D prescription drug plans cover duloxetine. To see if your specific plan offers coverage, ask to see the drug formulary. It tells you if duloxetine is covered, which versions are covered, and which tier each option is in.

Some Medicare Advantage plans also cover duloxetine. Specific coverage levels can vary dramatically based on your location and the plan you choose, so it's important to discuss expected costs with the insurer before you buy.

How Much Does Duloxetine Cost?

If you have a Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage for duloxetine, your costs may vary based on a number of factors. The most important factors are your insurance plan's copay and deductible. 

In 2024, Part D and Medicare Advantage plans can have a maximum drug deductible of $480. That means you'd need to pay for the first $545 of medication costs before the insurance kicks in. Your deductible may be as low as $0 or as high as $545, depending on your plan. 

After you meet your plan's deductible for the year, you may be responsible for a copay. This amount depends on the drug tier, the pharmacy you choose, your location and the availability of a generic option. Duloxetine is often classified as a Tier 2 drug. However, different plans have different tier classifications, so it's a good idea to check the tier for every plan you consider. In 2024, after your total drug costs reach $5,030, your copay is capped at 25% of the cost of the drugs. This continues until you reach your plan's out-of-pocket maximum.

Duloxetine Costs With Prescription Drug Discount Cards

Duloxetine tends to be a relatively affordable prescription drug. If your Part D plan has a $480 deductible, and you don't take any other prescriptions, the plan may not cover any of the costs. When this is the case, you can consider a prescription discount card in place of Medicare coverage.

As with insurance, prices can vary by pharmacy. With GoodRx, you can get a 30-day supply of duloxetine for as little as $5.19 at Costco or as much as $76.93 at QFC. With ScriptSave WellRx, the price of duloxetine also changes by location. For example, in Beverly Hills, California, you can expect prices ranging from $11.92-$62.25, but in Salt Lake City, Utah, prices range from $10.17-$165.87. 

Do You Need a Prescription for Duloxetine?

You need a prescription for all forms of duloxetine, regardless of the brand or dosage. Your doctor can provide more information about the recommended dosage.

Duloxetine Side Effects

The duloxetine products sold in the United States are regulated by the FDA. However, it's important to follow your doctor's dosing instructions carefully. Since the capsules are usually designed for delayed release, you'll likely be advised to swallow them whole at the same time each day.

In some cases, it can take up to 4 weeks for duloxetine to take effect. During that time, you may feel varying levels of relief. Depending on how your body reacts, your doctor may adjust the dosage.

Some potential side effects of duloxetine include:

• Nausea
• Diarrhea
• Heartburn
• Weight loss or gain
• Dizziness
• Headaches
• Dry mouth

It's always a good idea to keep your doctor updated on any side effects you experience. If you want to stop taking duloxetine, seek medical advice first; the sudden change can cause a range of unpleasant withdrawal symptoms.

As with many drugs, duloxetine can interact with other prescription, over-the-counter and natural medications. Make sure to give your doctor a full list of medications and vitamins, especially MAO inhibitors like Marplan or Zyvox. St. John's wort and tryptophan, which are often found in supplements, can also react with duloxetine.