Lupron (Leuprolide) Medicare Coverage
- Learn about Lupron (leuprolide), a medication used to treat the symptoms of endometriosis and prostate cancer. Find out whether Medicare covers this medication.
A brand name for leuprolide, Lupron is used to treat the symptoms of endometriosis or uterine fibroids for women and to treat the symptoms of advanced prostate cancer for men.
Does Medicare Cover Lupron?
Lupron is covered by 100% of Medicare prescription drug plans. That means if you have a Medicare Part D plan or a Medicare Advantage plan with prescription drug benefits, this medication should be covered under those benefits.
How Much Does Lupron Cost?
Without coverage, Lupron prescriptions can cost many hundreds of dollars. With Medicare coverage, how much you pay for this medication out of pocket depends on your plan and where you fall with deductibles or donut holes. If you haven't met your deductible, you will have to pay up to the deductible amount before Medicare will kick in to help cover the cost of the drugs. In 2022, Medicare prescription drug plans can't have deductibles more than $480.
After you meet the deductible, you may pay $5 to $684 for your prescription as part of your copay or coinsurance. Once you hit the donut hole, which occurs when Medicare has paid $4,130 (as of 2022) for prescriptions for you, you may pay $301 to $438 for this drug. If your out-of-pocket costs reach $6,550 for the year (as of 2022), you're beyond the donut hole and your copays lower to $3 to $38 for these medications.
Medicare Part C (or Advantage plans) may have different copay structures. These thresholds can also change every year, so it's a good idea to reach out to your Medicare representative for information about how much your prescriptions might cost so you can budget accordingly. You may also get assistance covering the costs of medication via Medicaid and pharmacy assistance plans.
How Is Lupron Taken?
Lupron is taken as an injection into a muscle or underneath the skin. A medical professional can perform the injection, or they can train the user on how to self-inject. The medication is generally taken monthly or once every 3 to 6 months.
What Are the Side Effects of Lupron?
Common side effects of Lupron include cold symptoms, muscle or joint pain, fatigue, appetite loss, constipation and vomiting. Irritation around the site where Lupron is injected can occur as well.
In women, Lupron reduces the amount of estrogen in the body. In men, it lowers the level of testosterone. Men may experience decreased testicle size, while women may experience vaginal itching, discharge or swelling.
More serious side effects that require immediate medical attention are allergic reactions such as face and throat swelling, hives, rashes, difficulty breathing and an increased heart rate.