Does Medicare Cover Dexilant?

Dexilant is a prescription medication that is used in treating and managing symptoms of medical conditions such as inflammation of the esophagus.

As of now, there are no generic alternatives for this prescription medication. It belongs to a class of drugs known as proton pump inhibitors. It is quite an expensive medication and not everyone who needs it can easily afford it.

Because of the high price, a lot of people want to know… “does Medicare cover Dexilant?” In this article, we answer that question in clear, plain English. You will also find the average cost of Dexilant and other helpful info.

Does Medicare Cover Dexilant?

The short answer is no. In most cases, Medicare will not cover the cost of Dexilant. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Dexilant. 

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for Dexilant. Parts A and B do not provide coverage for Dexilant because they mainly cover medically necessary services, equipment, and treatment rather than prescription drugs.

Part C and Part D Coverage for Dexilant

However, some Medicare Advantage plans (Medicare Part C) provide coverage for Dexilant. Medicare Advantage plans cover everything Original Medicare covers plus some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part D plans also provide coverage for Dexilant. However, only about half of both Medicare Part C and Part D plans provide coverage for the medication.

Most Medicare plans restrict the amount of purchase for Dexilant per one time. If you need to purchase a greater amount of Dexilant at one time, Medicare may not cover it. You can either wait until the period has passed before refilling or contact your plan provider and ask for an exception.

Dexilant is listed as a Tier 4 drug in the Medicare drug formulary. Most of the time Tier 4 medications are non-preferred brand medications. Tier 4 medications are more expensive than Tier 1, 2, and 3 medications. 

Most Medicare Part C and Part D plans have step therapy restrictions when it comes to this medication. The step therapy restrictions will require you to try a less expensive medication before they provide coverage for this drug.

How Much Does Dexilant Cost?

30 capsules of 60 mg Dexilant can cost you $370. This price will vary from pharmacy to pharmacy. 

What Are Some Alternatives For Dexilant?

Even though Dexilant does not have a generic alternative, here are some other medications that can be considered as an alternative:

For erosive esophagitis:

• Nexium (esomeprazole)
• Prevacid (lansoprazole)
• Prilosec (omeprazole)

For GERD:

• Nexium (esomeprazole)
• Prevacid (lansoprazole)
• Prilosec (omeprazole)
• Aciphex (rabeprazole)

Be sure to consult with your doctor to see if any of the above may work for your situation.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. 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 hospital stays?