Does Medicare Cover Otezla?

Medicare Benefits Solutions
Apr 2, 2021

Autoimmune disease can cause symptoms that are very difficult to manage on your own without the help of prescription medications. In response to these symptoms, your doctor could prescribe Otezla. This is a medication that can help you control your autoimmune disorder or condition while relieving your symptoms. It works well on swelling around your joints and inflammation. 

Medical conditions Otezla treats

Apremilast is better known by the brand name of Otezla, and the FDA approved this medication to help treat plaque psoriasis, psoriatic arthritis, and types of oral ulcers. This medication works to block the enzyme that plays a large role in your body’s overall immune response to any inflammatory triggers. Over time, this medication can slowly reduce your inflammation levels. 

If you get a prescription for this medication, you may start on a very low dose and slowly work your way up to the maximum dosage your doctor prescribes to handle your inflammation levels. This slow increase can take over a week, but your doctor will advise you on how to best go about it. You can take this medication with or without food, and you want to swallow it whole instead of splitting it into pieces, crushing it, or chewing it. 

Potential side effects and risks associated with Otezla

If this is your first time taking this medication, there is always a risk for an allergic reaction. If you have more severe problems like rashes, trouble swallowing, trouble breathing, or discomfort, you should seek immediate medical attention. 

There are a few possible side effects of this medication, including nausea, headaches, and stomach upset. If you take certain types of medication, it can make this medication less effective at controlling your inflammation. You should talk to your doctor about any supplements or medications you’re on and any health conditions before you start taking them. 

Otezla and Medicare coverage

Does Medicare insurance cover the cost of this prescription? Any prescriptions you fill at a pharmacy and take at home typically won’t be covered under Part A or Part B. However, you do have several choices when it comes to your prescription drug coverage. Medicare Part D is the prescription coverage option. If you have Original Medicare, you may want to enroll in a stand-alone plan through private insurers. You’ll also have to pay any copays, the monthly premium, and any deductibles. 

If you have a Medicare Advantage plan, it could include Part D coverage for your prescriptions. You’ll pay a monthly premium for your Medicare Advantage plan, and this includes your premium for your prescriptions. Some Medicare Advantage plans will also give you additional coverage options, and they can lower your deductible and copay out-of-pocket costs. 

If you’re a low-income Medicare recipient, your state’s Medicaid program could help you cover your prescription costs. Each state has a set of eligibility rules and criteria you have to be in order to get additional help. 

Otezla costs

Costs and coverage for drugs may vary between Part D plans. It’s a good idea to talk to your insurance representative to make sure Otezla has coverage, especially if you’re a Medicare recipient. 

If your Medicare coverage won’t pay for your prescription or if you don’t have insurance, you’ll pay around $900 for 27 tablets that range between 10 and 30-milligrams. The prices can vary based on your location, dosage, and whether or not you qualify for your state’s Medicaid program.