Does Medicare Cover Zyprexa?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 10/05/2018

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Oral Zyprexa can be used to treat schizophrenia and bipolar I disorder, according to the National Institute of Health (NIH). Do you wonder if Medicare covers your Zyprexa? The answer is that Medicare generally does not cover Zyprexa, or the generic olanzapine, unless you have a stand alone Medicare Part D Prescription Drug Plan or a Medicare Advantage plan that covers prescriptions.

Learn more about Medicare coverage for Zyprexa or olanzapine.

Why does Medicare Part A not cover my Zyprexa?

Medicare Part A usually does not pay for prescriptions except those that you receive when you are an inpatient during a covered stay in a hospital or skilled nursing facility. Medicare Part A covers:

  • Hospital care (including inpatient mental health care in a psychiatric or other hospital)
  • Nursing home care as long as custodial care (non-skilled personal care) is not the only care needed
  • Skilled nursing facility care
  • Home health care services (not including personal care like bathing and dressing)
  • Hospice care

Why does Medicare Part B not cover Zyprexa or olanzapine?

Medicare Part B generally does not cover prescriptions. Medicare Part B coverage includes:

  • Outpatient physician visits
  • Outpatient labs
  • Preventive services such as certain vaccinations and cancer screenings
  • Medical supplies such as a walker or wheelchair that a physician considers medically necessary
  • Mental health services

Perhaps you have heard that Medicare Part B covers “Limited outpatient prescription drugs,” and wonder if that could include Zyprexa or olanzapine. Limited outpatient prescription drugs are generally those that you would not normally administer at home but receive in a doctor’s office or hospital outpatient facility

Medications covered by Part B could include medications administered by infusion pump or nebulizer, injectable osteoporosis drugs, vaccinations, injectable and infused prescription drugs given by a licensed medical provider, and intravenous and tube feeding, for example.

Does a Stand-Alone Medicare Part D Prescription Drug Plan cover Zyprexa?

If you enroll in a stand- alone Medicare Part D Prescription Drug Plan, you may have coverage for Zyprexa or the generic, olanzapine. Whether your stand-alone Medicare Part D Prescription Drug Plan covers Zyprexa depends on whether the medication is listed in the provider’s list of covered drugs, called a formulary.

While a stand- alone Medicare Part D Prescription Drug Plan provides beneficiaries with a copy of their annual formulary, that formulary may change at any time. Your Medicare Part D Prescription Drug Plan Provider provides notice before formulary changes go into effect.

Does Medicare Cover Zyprexa Under a Medicare Advantage Prescription Drug Plan?

If you enroll in a Medicare Advantage plan, referred to as Medicare Part C, you may receive coverage for prescriptions, such as Zyprexa or olanzapine, along with other coverage benefits.

Medicare Advantage plans includes benefits normally covered under both Medicare Part A and Medicare Part B and sometimes extra benefits, such as vision or dental. Original Medicare Part A still covers hospice care.

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