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Medicare Updates: Xanax Coverage Explained

Xanax is one of the most prescribed medications in the United States, and many people over the age of 65 take this medicine to help manage a variety of health conditions. Although previously excluded from Medicare coverage, Xanax is now a covered medication. This article will explore Medicare coverage of Xanax and some other considerations regarding the use of this drug.


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What is Xanax?

Xanax is a prescription medication typically prescribed for those with health conditions such as panic disorders and various types of anxiety disorders. The medication is part of a class of drugs known as benzodiazepines and is the most prescribed medication for mental health conditions within the United States. Other important things to know about Xanax are listed below.

  • Xanax and other medications within this drug class are categorized as controlled substances, which means the medications have some potential to be abused or taken inappropriately.
  • Based on regulations, the prescriptions are valid for six months from the date written and may be refilled up to five times within the six-month window.
  • Xanax does come in a generic form called alprazolam and is available as a tablet or liquid.

Does Medicare cover Xanax?

Medicare has not always covered Xanax or any other benzodiazepine. However, regulatory changes were made in 2013 that expanded Medicare coverage of certain drugs to include Xanax. Prescription drugs are covered by Medicare Part D, and most plans cover Xanax. It’s also important to know about Xanax coverage under other parts of Medicare.

  • Medicare Part A. While Medicare Part A does not cover prescription drugs, it will cover Xanax if you are given the medication during an inpatient hospital stay.
  • Medicare Part B. This part of Medicare only covers a small amount of prescription medications. Many medications are given in an outpatient clinical setting, such as a doctor’s office, emergency department, or surgery center. Prescription medications filled at a retail pharmacy are typically not covered.
  • Medicare Part D. At the start of the Medicare Part D program in 2006, benzodiazepines, including Xanax, were not covered. However, Xanax has been covered by Medicare Part D since 2013. If you do not have Medicare Part D and would like to enroll in a plan, you may do so if you are covered by Original Medicare (Medicare Part A and B).
  • Medicare Advantage. If your Medicare Advantage (Medicare Part C) plan includes a prescription drug plan or Medicare part D, it should cover the cost of Xanax.
  • Medigap. Medigap is offered by private health insurance companies and is meant to supplement Original Medicare coverage. Unfortunately, prescription drug coverage is not included in Medigap plans. You’ll need to enroll in a Medicare Advantage Drug or Medicare Part D plan to get your prescriptions covered.
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What is the cost of Xanax under Medicare?

Since Xanax is available in generic forms and classified as a controlled substance drug, several factors will determine how much you will pay for the medication. Essential plan elements that you should review include:

  • Drug tiers. Review your plan's formulary medication list to determine which drug tier includes Xanax. Since Xanax is available in a generic form, it may be listed in a different tier than the brand name. The generic form may also have a lower copay. If you need the brand name Xanax, it’s likely listed in one of the brand name drug tiers (preferred or non-preferred) and could have a higher copay.
  • Prior authorization. Some medications may require your provider to submit paperwork to your insurance company for approval before they cover it. This may be the case for drugs such as Xanax that are available in brand name and generic forms. If you need the brand name Xanax, your doctor may have to show evidence that it’s medically necessary and no alternatives are available.
  • Quantity limits. Depending on your dose of Xanax and how often it’s taken, you may be limited to the amount of medication you can receive per month. Review your plan's quantity limits based on your medication regimen.
  • Network pharmacies. These pharmacies have partnered with Medicare and have agreed to provide beneficiaries with prescription drug services. Specific insurance plans may only offer coverage if you use a pharmacy in their network. It is essential to check with your insurance provider about their specific requirements.
  • Preferred pharmacies. These pharmacies are in your plan's network and have partnered with your insurance company to provide prescriptions at a reduced cost. Your copays may be cheaper if you use a preferred pharmacy.

Your options for drug coverage are based on where you live within the United States. You can visit Medicare.gov to see which plans are available in your area. Below are potential monthly drug costs from some of the best Medicare Part D plans for 2024.

Insurance planMonthly cost
United Healthcare$10.91
Humana$3.20
Aetna$3.68
Wellcare$4.00
Cigna$3.85

The prices above are current as of January 2024. The table shows monthly costs for a 30-day supply of 90 generic 1 mg Xanax tablets from a preferred or network pharmacy within the Houston, Texas area.

Is additional support available?

If you struggle to pay your copays with Medicare, other assistance programs are available. One such program is Extra Help. This is a federal program for individuals with limited income to assist with reducing the cost of medication copays.

In 2024, those individuals who qualify for the Extra Help program will pay no out-of-pocket costs for their prescription drug plan monthly premium or deductible. Individuals who receive Supplemental Security Income or are fully covered by Medicaid qualify for Extra Help automatically.

Medicare Part D has been covering Xanax and other medications within this drug class for over 10 years, and many older adults use Xanax. While it’s mainly used for panic and anxiety orders, it is also used to help treat other conditions as well.

Note
Do not stop or change how you take Xanax without first speaking with your medical provider.

Xanax can potentially be habit-forming, and it’s essential to take the medication only as prescribed by your healthcare provider.

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