Does Medicare Cover Trelegy?

Trelegy Ellipta is a medication that is mainly used to treat chronic obstructive pulmonary disease. This medication does not have any generic alternatives and is less common compared to other drugs for the same illness.

If this is a medication your doctor is recommending, you may have the question “does Medicare cover Trelegy Ellipta?” In this article, we answer that question in clear, plain English. You will also find the average costs of Trelegy and other helpful info.

The short answer is no for Original Medicare but a likely yes if you have Part D coverage. In most cases, Original Medicare will not cover the cost of Trelegy Ellipta. 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 Trelegy Ellipta.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for Trelegy Ellipta. 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 by Medicare Part D.

Part C and Part D Coverage for Trelegy

Some Medicare Advantage plans (Medicare Part C) provide coverage for Trelegy Ellipta. Medicare Advantage plans have to cover the same treatments and services Original Medicare covers. But they offer additional benefits too. Exactly what those additional benefits are and how much coverage for those benefits cost will depend on the Advantage plan.

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

Medicare Part D plans also provide coverage for Trelegy Ellipta. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies. Currently 87 percent of both Medicare Part C and Part D plans provide coverage for the medication Trelegy Ellipta.

Most Medicare plans restrict the amount of Trelegy Ellipta you can get at one time. If you need to purchase a greater amount of Trelegy Ellipta then Medicare permits at one time, Medicare may not cover it. In this case, you can either wait until the period has passed before refilling your prescription or contact your plan provider and ask for an exception.

Trelegy Ellipta is usually listed as a Tier 3 drug in the Medicare drug formulary. Most of the time Tier 3 medications are preferred branded medications. Tier 3 medications are more expensive than Tier 1 and 2 medications.

How Much Does Trelegy Ellipta Cost With Medicare and Without It?

Depending on the pharmacy, if you pay out of pocket for Trelegy, the cost will range from $610 – $710. However, you can often find some discounts available through various sources like the manufacturer or drug discount plans.

The cost of Trelegy with Medicare will depend on your plan as well as what coverage stage you’re in for Medicare Part D. The copayment can range from as little as $1 to as much as $692.

What Are The Side Effects Of Trelegy Ellipta?

Some of the reported side effects of Trelegy Ellipta are the following:

Back pain (mild)
Cough (mild)
Diarrhea (mild)
Headache (mild)
Allergic reactions (if you have an allergy for this medication, severe)
Chest pain (severe)
Fast, irregular heartbeat (severe)
Problems in breathing after intake (severe)
Symptoms of high blood sugar (severe)
Lightheaded (severe)
Fever (severe)

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.