Does Medicare cover Sterapred?
Last Updated : 09/12/20184 min read
Sterapred is a brand-name preparation of prednisone. According to the National Institutes of Health’s Medline Plus website, prednisone is a corticosteroid used to treat a wide variety of conditions, including arthritis, multiple sclerosis, lupus, certain types of cancer, and many others. Some Medicare plans may cover Sterapred.
Depending on the health condition you have, Sterapred may work in different ways, according to Medline Plus.
- If you have low corticosteroid levels, a corticosteroid drug replaces steroids your body would produce naturally in a healthy person.
- Sterapred may treat other conditions by reducing swelling and redness and by changing the way the immune system works.
If your doctor prescribes Sterapred, it is usually not covered by Original Medicare (Part A and Part B). However, if you’re enrolled in a Medicare plan option that includes prescription drug benefits, this drug might be covered.
When does Medicare cover Sterapred?
There are four parts to the Medicare program: Part A (hospital insurance) and Part B (medical insurance), called Original Medicare; Part C (Medicare Advantage), and Part D (prescription drug coverage).
Under Original Medicare, Part A and Part B, prescription drug coverage is limited. Part A may cover prescription medications if you receive them as part of your treatment as an inpatient in the hospital. Part B covers certain medications administered to you as an outpatient.
For most medications you take at home, such as Sterapred, you’d need to enroll in a stand-alone Medicare Part D Prescription Drug Plan, or a Medicare Advantage Prescription Drug plan to get your prescriptions covered.
Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage plans are offered by private insurance companies contracted with Medicare. In a nutshell, the difference between these plan options is that a stand-alone Medicare Part D Prescription Drug Plan is meant to work alongside your Original Medicare benefits, while a Medicare Advantage plan is a different way to get your Medicare benefits. Medicare Advantage plans include all your Medicare Part A and Part B benefits (except for hospice care, which Part A still covers), and most of them include prescription drug coverage as well. You still need to pay your monthly Part B premium, plus any premium your plan may charge.
All Medicare plans maintain formularies, or lists of covered medications, to determine coverage for medications such as Sterapred.
If you’re comparing plans, it may be a good idea to see if the plan’s formulary includes prednisone, or any prescription drugs you take regularly. Note that a plan’s formulary may change at any time. You will receive notice from your plan when necessary
Who can enroll in Medicare prescription drug coverage for medications like Sterapred?
Anyone who is eligible for Medicare can generally enroll in prescription drug coverage under Medicare Part D, or Part C (Medicare Advantage – if the plan has this coverage).
If you are enrolled in Original Medicare (Part A and/or Part B), or certain types of other Medicare health plans, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan to complement your coverage.
If you prefer the Medicare Advantage program, you may be able to enroll in a Medicare Advantage plan, such as a Medicare Advantage Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO)* plan, that includes Part D coverage for prescription drugs. Not every plan includes this coverage, so check with the plan before you sign up.
When can I enroll in Medicare prescription drug coverage for medications like Sterapred?
Enrollment in Medicare prescription drug coverage is entirely voluntary; however, if you think you want coverage for Sterapred or other medications your doctor may prescribe, you might want to enroll as soon as you are eligible to avoid paying a late-enrollment penalty with your premium each month.
If you take prednisone or other prescription medications and would like assistance finding Medicare coverage options, I’m available to answer your questions. You can request information via email or schedule a phone call at your convenience by clicking one of the links below. To see a list of plans in your area that you may qualify for, click the Compare Plans or Find Plans button.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.