Does Medicare Cover Linzess?

Medicare Benefits Solutions

Medicare Benefits Solutions
Jan 4, 2021

Linzess is a prescription medication that patients may get if they have a history of suffering from types of bowel disorders. Examples of these disorders include perpetual constipation without a known cause, or irritable bowel syndrome with constipation. The generic name for this drug is Linacoltide, and many people with bowel disorders who have Medicare benefits wonder if it’ll pay for it. 

Understanding Linzess

Chronic idiopathic constipation and IBS have symptoms that come with them, including feeling like you had an incomplete bowel movement, abdominal pain, and bloating. This medication works to raise the fluid levels in your intestines, and this can push the food through your system faster. In turn, this can alleviate your symptoms. You’ll typically take this medication once per day, but your doctor will give you a schedule. 

Medicare Beneficiaries and Constipation

Many Medicare recipients complain about constipation, and the number of people who have it seems to go up as they age, according to National Library of Medicine. Among people 65 years old, over 20% of women and over 10% of men report experiencing it. When you get over 80 years old, this number goes up to over 30% for women and 20% for men. For long-term residents, this percentage easily tops 80%. 

To help avoid problems with constipation as you get older, you may find yourself shifting toward a well-balanced diet that has good sources of fiber like beans, vegetables, and carbohydrates from whole grains. Drinking less caffeine and more water while adding regular exercise to your routine can help too. It’s a good idea to talk to your nutritionist or primary care doctor to find out if switching your lifestyle habits can help with your constipation levels. 

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Medicare Benefits and Linzess

All Medicare recipients have access to drug coverage under Medicare Part D. You can choose to enroll in a Medicare Prescription Drug Plan as an add-on, if you have Original Medicare. But, you have to enroll in Part A and/or Part B first.

You could also choose an alternative to Original Medicare and sign up for a Medicare Advantage plan. Medicare Advantage plans must include the same minimum coverage as Parts A & B, and many also include Part D. Part D does vary in coverage for Medicare Advantage plans based on your plan and your location. If you plan to move, you should get in touch with your plan administrator and make sure that the same benefits will carry over to your new location. Almost all Part D and Medicare Advantage plans will help cover the cost of Linzess.

Every plan categorizes its drugs in tiers. Medicare usually puts Linzess at a Tier 3 drug. This means that the Medicare recipient’s total cost will depend on several factors. These factors include whether or not your pharmacy is in-network, the drug tier Linzess is on under your plan, the plan deductible, and whether or not you buy it using a bulk mail-order system. 

This is a slightly more expensive drug as there are no generics available for it yet. You can expect to pay around $475 for a supply of 30 72-milligram capsules. This price will fluctuate depending on the pharmacy you visit. This price is for people who pay with cash or a credit card with no insurance.

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