Does Medicare Cover Xalatan?
Last Updated : 10/23/20194 min read
Xalatan is an ophthalmic solution approved by the United Stated Food and Drug Administration to treat certain types of eye conditions including open-angle glaucoma or ocular hypertension. Xalatan and its generic, latanoprost, may be covered by a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage.
Which part of Medicare covers prescription drugs?
Medicare coverage is broken up into four parts, which offer different types of coverage. These parts are:
- Medicare Part A: Hospital coverage, as well as hospice, skilled nursing care and nursing home care
- Medicare Part B: Medical insurance, including visits to doctors, preventive health care, and durable medical equipment
- Medicare Part C: Medicare Advantage plans (may include prescription drug coverage for prescriptions such as Xalatan)
- Medicare Part D: Prescription drug coverage, which may include Xalatan
Medicare Part A and Part B are called “Original Medicare” and do not cover prescription drugs in most cases, unless you are receiving the prescription drug as an inpatient or a doctor is administering the prescription drug to you. If you have Original Medicare and want coverage for prescription drugs you take at home, you generally must enroll in a Medicare Part D Prescription Drug Plan. Private insurance companies contracted with Medicare that offer Medicare Part D coverage for prescription drugs use formularies to determine benefits for various medications. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
How do I get Medicare prescription drug coverage for Xalatan?
In order to be eligible for Medicare prescription drug coverage, you generally must be 65 years or older or have a disability and enrolled in the Medicare program during one of two periods each year or your seven-month initial enrollment period. Your initial enrollment period begins three months before you turn 65, the month of your 65th birthday, and ends three months after you turn 65. If you are disabled, you initial enrollment period is also seven months and includes the three months before, one month during and three months after your 25th month of getting disability benefits from Social Security or the Railroad Retirement Board. You can opt for Medicare Part D coverage if you have Medicare Part A or Medicare Part B. If you enroll in Original Medicare but wait to sign up for Medicare Part D, you may be required to pay a late-enrollment fee.
While you may enroll in a stand-alone Part D Prescription Drug Plan that covers Xalatan, you may also choose to sign up for a Medicare Advantage plan that includes prescription drug coverage. Medicare Advantage plans are offered as an alternative way to get Original Medicare benefits, except for hospice care, which Medicare Part A still covers. You may be able to find a Medicare Advantage plan in your area that covers prescription drugs, although you must confirm that the individual plan covers Xalatan.
How does Medicare cover Xalatan?
Your prescription drug coverage for Xalatan depends on the pharmacy as well as the details of your specific plan. Not all prescription drug plans will cover Xalatan. As you research plans, you must check each plan formulary to see if it covers Xalatan. The plan formulary could change at any time, and you will receive notice when needed.
I am happy to help you identify your Medicare plan options that may cover Xalatan or other medications.
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