Does Medicare Cover Premarin?

Victoria Burke by Victoria Burke | Licensed since 2011
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This article was updated on: 09/10/2018

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Menopause can result in hormone fluctuations that cause symptoms such as hot flashes or vaginal dryness. To help with the symptoms of menopause and to help protect against osteoporosis, your doctor may prescribe hormone replacement therapy such as Premarin.

What is Premarin?

If you’re experiencing symptoms of menopause, your doctor might prescribe Premarin to treat you. Premarin contains conjugated estrogens derived from pregnant mares’ urine, according to the Food and Drug Administration (FDA).Conjugated estrogens like Premarin contain a mixture of estrogen hormones.  According to the FDA, treatment with estrogens such as Premarin has risks, including the increased risk of endometrial cancer, and Premarin should be prescribed at the lowest effective dose for the shortest duration to accomplish treatment goals for the individual woman.

Does Medicare cover Premarin?

Medicare prescription drug coverage is optional, and you don’t get it automatically with Original Medicare, Part A and Part B. Prescription drug coverage for drugs such as Premarin is available through private insurance companies that contract with Medicare. If you want to stay with Original Medicare, you can add a stand-alone Medicare Prescription Drug plan to cover Premarin. If you’d rather get all your Medicare coverage through one policy, you can sign up for a Medicare Advantage (Part C) Prescription Drug plan that covers your inpatient care, outpatient care, and prescription drugs such as Premarin.

Does my formulary cover Premarin?

Medicare prescription drug plans maintain lists of the drugs they cover, called formularies. Within each formulary, plans put medications into separate categories called tiers. Higher tiers typically list higher-priced medications, such as many name-brand drugs, while lower-priced drugs such as some generics tend to populate the lower tiers. Additionally, the formulary may change at any time. You will receive notice from your plan when necessary.

If your doctor prescribes Premarin, check your plan’s formulary to see if it’s covered. If Premarin is not covered or if it’s in a higher tier, you might want to consult with your doctor about suitable alternatives that might be in your plan’s formulary, possibly at lower prices. Your copayment, deductible, or other medication costs may differ among drug plans.

Need help finding a Medicare plan that covers Premarin?

Is it time to upgrade your Medicare prescription drug plan to make sure your medications such as Premarin are covered? I love to help people get Medicare plans that fit their situations. We can set up a telephone call whenever it’s convenient for you, or you can request information from me by email, if you follow the links at the end of this article. Why not take a quick look at available plans in your area right now? You can click the Compare Plans buttons on this page to do that.

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