Does Medicare cover Risperdal?

Victoria Burke by Victoria Burke | Licensed since 2011
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This article was updated on: 09/12/2018

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Risperdal, the brand name formulation of the generic drug risperidone used to treat symptoms of schizophrenia and bipolar disorder, is generally not covered under Original Medicare (Part A and Part B), unless you have Medicare Part D prescription drug coverage or a Medicare Advantage plan that includes prescription drugs. If you take Risperdal and want to know how to get Medicare coverage for your medication, here’s what you need to know.

When does Medicare cover Risperdal?

Original Medicare usually does not cover any prescription medication you take at home. The only time Medicare might pay for Risperdal is if you receive it while you are an inpatient in the hospital or other facility during a covered stay.

If you have Medicare Part D coverage for prescription drugs, your plan will most likely cover treatment with Risperdal at home. Risperdal is in a class of drugs known as anti-psychotics, which is considered a protected class under Medicare Part D prescription drug coverage. This means that all Part D Prescription Drug Plans must cover all, or substantially all that are FDA approved, of the medications in that class.

Please note, your plan formulary may place certain conditions on filling a prescription for Risperdal and other prescription medications. A formulary is simply the plan’s list of covered medications, the benefits available for each, and any special requirements for that medication. For example, your plan may require that your doctor gets prior approval before prescribing Risperdal, or it may limit the number of pills or doses you can obtain at one time. A plan may change its formulary at anytime, but it must notify you in writing before any changes take effect.

How can I get Medicare Part D prescription drug coverage for Risperdal?

If you want Medicare Part D prescription drug coverage, it’s important to enroll as soon as you are eligible. Otherwise, you may have to pay a late-enrollment penalty with your monthly premium for as long as you have coverage.

You can get Medicare Part D coverage for prescription drugs in one of two ways:

  • If you have Original Medicare or certain other types of Medicare health plans, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan.
  • You can enroll in a Medicare Advantage plan with coverage for prescription drugs, often known as MAPD.

If you are under a doctor’s care for schizophrenia, bipolar disorder, depression, or other type of mood disorder treated with Risperdal, you may want to consider a Medicare Advantage plan as a way to better plan for your out-of-pocket health-care costs. Medicare Advantage plans are an alternate way to get all your Medicare benefits in one easy-to-manage plan. These plans must offer the same coverage, at a minimum, as Original Medicare (except for hospice care, which is still covered under Part A), but many include extra benefits for routine dental and vision care and wellness programs to help you better manage your condition.

Medicare Advantage plans and Medicare Part D Prescription Drug Plans are offered by private insurance companies approved by Medicare. This means that plan premiums, benefits, deductibles, copayments, and/or coinsurance amounts may vary depending on where you live and the type of plan you select. Not all plan types may be available in all locations.

Would you like more information about Medicare options for coverage of mood disorders and treatment with Risperdal? 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. To see a list of plans in your area that you may qualify for, click the Compare Plans or Find Plans buttons.

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