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Does Medicare Cover Advair?

Does Medicare Cover Advair?

One common asthma treatment is fluticasone/salmeterol (Advair, Airduo, Wixela Inhub). This drug is more popular than other combinations of beta-agonists and corticosteroids.

There are both brand-name and generic versions available. Most Medicare and insurance plans cover generic fluticasone/salmeterol, but some pharmacy coupons or cash prices may be lower.

If this is a drug you or a loved one need, a common question is, “Does Medicare cover Advair?” In this article, we answer the question in clear, plain English. You will also find the average costs of Advair and other helpful info.

Does Medicare Cover Advair?

The short answer is no. Original Medicare typically will not cover the cost of Advair. However, you may be able to get coverage through a Medicare Part C or D plan. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Advair.

Original Medicare 

Original Medicare (Medicare Part A and Part B) does not provide coverage for Advair. That is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or Medicare Part D.  

Medicare Advantage

However, some Medicare Advantage plans (Medicare Part C) provide coverage for Advair. Medicare Advantage plans cover everything Original Medicare covers but offer benefits that Parts A & B do not.

However, what a Part C plan covers and how much the out-of-pocket costs are will vary depending on your plan. Medicare Part C plans that include prescription drug plans may provide coverage for Advair or related medications.

Medicare Part D plans may also provide coverage for Advair. Part D is a prescription drug plan. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

Seventy-six percent of Medicare Part C and Part D plans provide coverage for the medication Advair. 

Some Medicare plans restrict the amount of Advair you can get at one time. Medicare may not cover if you need to purchase more Advair than allowed.

In this case, you can either wait until the period has passed before refilling or, if you need to purchase greater amounts of Advair within the period, you can contact your plan provider and ask for an exception.

Advair is listed as a tier 3 drug in the Medicare drug formulary. Most of the time, the Medicare drug formulary only has five tiers. Tier 3 medications usually are preferred branded medicines. Tier 3 medications are more expensive than Tier 1 and 2 medications.

Coverage for Inhaler Costs

Original Medicare also provides coverage for asthma inhaler costs. Medicare Part B provides coverage for asthma inhalers. However, for Medicare Part B to cover asthma inhalers, your healthcare provider has to prescribe it and fill out a form stating why it is medically necessary.

Medicare considers asthma inhalers as Durable Medical Equipment or, in short, DME. Part B provides coverage for DME. Medicare Part B also covers nebulizers

Medicare Part B will cover the cost of albuterol if used with a nebulizer. Besides asthma inhalers and medications, Medicare Part A and B also provide coverage for asthma treatment, including outpatient asthma rehabilitation. 

Medicare Advantage plans (Medicare Part C) and Part D plans also provide coverage for asthma inhalers.

But similar to Part B’s coverage, you will need a prescription from your healthcare provider before Medicare Part D covers asthma inhalers.

Medicare Advantage plans with Part D may cover Symbicort. But Medicare Part D alone can also cover Symbicort. Medicare Part D also covers albuterol as long as it is used with an asthma inhaler. Though Original Medicare does not cover rescue inhalers, some Medicare Part D plans may cover them. To know which Medicare Part D plans cover rescue inhalers, you can compare different Part D plans in your area. 

How Much Does Advair Cost?

The average cost of 1 diskus inhaler of Advair 250mcg/50mcg is around $470. 

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series, including: Does Medicare cover iron infusions?

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