Does Medicare Cover Promacta?

Promacta, also known by its generic name Eltrombopag, is a medication that treats a few different conditions or diseases.  

One is low platelet levels due to a medical condition called chronic immune (idiopathic) thrombocytopenic purpura (ITP). Another condition it treats is chronic hepatitis C. It may also be used on the blood disorder aplastic anemia.  

If your doctor recommends this med to you, you may be wondering, “Does Medicare cover Promacta?” In this article, we answer that question in clear, plain English. You will also find the average costs of Promacta and other helpful info. 

Does Medicare Cover Promacta? 

The short answer is yes; Medicare will cover the cost of Promacta. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Promacta. Below we look at what these are so you know what to expect. 

Original Medicare (Medicare Part A and Part B) will provide coverage for Promacta.  

Medicare Advantage plans (Medicare Part C) also provide coverage for Promacta. They cover everything Original Medicare covers along with some additional benefits. However, exactly what it covers, and how much the out-of-pocket costs are, will vary depending on the specifics of your plan.  

Not only do all Part C plan cover this med, but all Medicare Part D plans also provide coverage for Promacta.  

That said, there are some restrictions on coverage for this drug.  

Most Medicare plans restrict the amount of Promacta you can get in a given timeframe. If you need to get a greater amount of Promacta in that timeframe, Medicare may not cover it.  

If this is the case, you have a few options. One is to wait until the time period is over before refilling it. Or, if you really need to purchase greater amounts of Promacta, you can contact your plan provider and ask for an exception. 

Also, before Medicare provides coverage for Promacta, you will need to obtain their authorization. In order to obtain authorization from Medicare, you will have to contact your plan provider. They, in turn, may require a document from your healthcare provider stating why you need the drug.  

Also, Medicare places Promacta in tier 5 of their formulary. Tier 5 drugs are more expensive than tier 1-4 drugs. Medicare may cover the costs in full or may require you to pay a co-payment fee.  

How Much Does Promacta Cost? 

A single unit of 12.5 mg of Promacta powder for reconstruction costs a little under $200. 30 units of the powder for reconstruction costs around $6,000.  

Requirements Before Taking Promacta 

You must take a Promacta without a meal. Or, if you do have it with a meal, it must be one that is low in calcium (50 milligrams or less). Also, you must take this medication at least 2 hours before or 4 hours after consuming anything that contains magnesium, aluminum, and calcium-rich foods.  

Promacta is available as a film-coated tablet and oral suspension. It should not be split, chewed, or crushed before taking it.  

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 ER visits?