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Does Medicare Cover Lidocaine Patches?

Does Medicare Cover Lidocaine Patches?

Lidocaine, often known by its brand name Lidoderm, is a relatively affordable medication that can prevent and treat pain caused by certain procedures.

This medicine is far more popular than other drugs that are equivalent to it. It is marketed under various brand names and is also sold in its generic form.

So a common question many people have is, “Does Medicare cover lidocaine patches?” In this article, we answer the question in clear, plain English. You will also find the average costs of lidocaine patches if you have to pay for them out of pocket.

Does Medicare Cover Lidocaine Patches?

The short answer is no. In most cases, Medicare will not cover the cost of Lidocaine Patches. 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 lidocaine patches. 

Original Medicare

Medicare Part A and Part B do not provide coverage for Lidocaine Patches. 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 lidocaine patches.

Medicare Advantage plans cover everything Original Medicare covers but will offer some additional benefits Part A or B do not cover. But coverage and out-of-pocket costs will vary depending on the plan you get.

Part C plans that include prescription drug plans will also provide coverage for medications your healthcare provider will prescribe to you.

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

One hundred percent of both Medicare Part C and Part D plans provide coverage for the medication lidocaine patches. 

How Much Lidocaine Will Medicare Cover?

Most Medicare Advantage plans restrict the amount of purchase for lidocaine patches per one time. Medicare may not cover if you need to purchase more lidocaine patches at a time.

You can either wait until the period has passed before refilling. If you need to purchase more lidocaine patches, you can contact your plan provider and ask for an exception.

Lidocaine patches are listed as a tier 4 drug in the Medicare drug formulary. Most of the time, the Medicare drug formulary only has five tiers. Tier 4 medications are branded as more expensive medications. Tier 4 medications are more expensive than Tier 1, 2, and 3.

Most Medicare plans may also require you to have prior authorization before providing coverage for this medication. The usage of this medication has to be for medically necessary purposes. You must contact your plan provider to get authorization. 

How Much Do Lidocaine Patches Cost?

The average retail price of 30 Patches of lidocaine 5 percent costs $245.63.

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 Nucala?

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Medicare Plan Tips Team

Annie Kaye is a writer and researcher who was thrown into the Medicare world while taking care of her ailing mother. Even with a degree in Library Science and a long history of fighting for what's right, she felt lost. She learned a lot about Medicare during that time and now writes to help others understand how the system works.