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Medicare & Gastroparesis Medication

Medicare & Gastroparesis Medication

August is Gastroparesis Awareness Month, which is committed to finding solutions for patients with the condition. The overarching goal is to improve understanding and help patients and families manage the disease. If you have questions about which prescription medications are covered under Medicare — including ones to treat gastroparesis — we can help.  

What Is Gastroparesis?

Gastroparesis is a condition where food stays in the stomach for longer than normal. The cause might be nerve damage that can interrupt digestion, lead to nausea and vomiting, and create issues with nutrition and blood sugar levels. Other symptoms include heartburn and feeling full after eating little food.  

Medications, diet changes, and possibly surgery may provide relief. 

Medications to Treat Gastroparesis

A doctor may prescribe medications to spur the stomach muscles, including metoclopramide (Reglan) and erythromycin (Eryc, E.E.S.)

Domperidone is a newer medication with fewer side effects. It’s available with limited access.

Other drug options include prochlorperazine (Compro) and diphenhydramine (Benadryl, Unisom), which help control nausea and vomiting.  

Does Medicare Cover Reglan?

Most Part C (Medicare Advantage) and Part D (prescription drug) plans cover metoclopramide or Reglan. 

Note: costs and coverage of prescription medications will vary depending on plan availability.

Average Costs for Metoclopramide with Medicare Coverage

Your copay and deductible for any prescription drug can vary. It depends on your coverage stage and the particular drug plan you have. 

Your deductible is the annual amount you must pay for your prescriptions before your Medicare plan pays its share.  

Deductible stageUsual copay stage
You must pay the full rate for your prescription drugs.

Some Medicare drug plans have a $0 deductible. In 2020, these plans can’t have a deductible of more than $435.  
After you reach your Part D deductible, you start the initial coverage period.

During this phase, you pay a flat fee (copayment) or percentage (coinsurance) for your covered medications.

MA-PD

Some Medicare Advantage plans feature built-in drug coverage, also called MA-PD (Medicare Advantage Prescription Drug Plans). The majority of folks who have Medicare Advantage are enrolled in MA-PDs.

Tier 1 Prescriptions Are Generics

Medicare drug plans have a formulary (drug list) that identifies and explains the covered prescriptions. 

Medicare plans usually list metoclopramide in Tier 1 of their formulary. Tier 1 prescriptions are typically inexpensive generics. So, your co-pay will be reasonably low.

Looking for Plans in Your Area? We Can Help

When you need to look for Medicare Advantage plans in your area that cover Reglan, we can help. If you want help comparing Part D plans in your area, an agent at Trusted Senior Specialists can assist you.    

What Other Prescriptions Does Medicare Cover?

Medicare Part B is your medical insurance. It covers some outpatient prescription drugs under controlled conditions. Here are some examples:  

  • Some antigens
  • Blood clotting factors
  • Injectable osteoporosis drugs
  • Flu shots and other vaccinations
  • Erythropoiesis-stimulating agents
  • Drugs infused through a nebulizer
  • Transplant / immunosuppressive drugs
  • Oral End-Stage Renal Disease (ESRD) drugs
  • Intravenous Immune Globulin (IVIG) provided in the home

Contact Trusted Senior Specialists

If you need to fill prescriptions for Reglan or Metoclopramide, we can help you find a Medicare plan covering this prescription. Contact Trusted Senior Specialists to discuss your Medicare options!   

This article is strictly for informational purposes. It’s not healthcare diagnosis, advice, or treatment. It’s not a sanction of or suggestion for this medication. Talk to your doctor or healthcare provider regarding your specific healthcare needs, including your prescriptions. Only take medication as prescribed by your doctor.

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