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Type 2 diabetes is the most prevalent form of diabetes in the United States, impacting millions of people.
Variable factors contributing to type 2 diabetes include obesity, smoking, and inactivity. In type 2 diabetes, insulin resistance impairs the body’s capacity to regulate insulin production and properly utilize insulin.
One treatment option is Victoza, an injectable drug that helps to stimulate the production of insulin in the body.
If this treatment can help you, a common question is, “Does Medicare cover Victoza?” In this article, we answer the question in clear, plain English. You will also find the average costs of Victoza and other helpful info.
Does Medicare Cover Victoza?
The short answer is yes. Over 90% of Medicare prescription drug plans cover Victoza. Below we’ll take a more in-depth look at coverage for this drug.
Medicare Part A and Part B do not provide coverage for Victoza. Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage is typically provided by either Medicare Advantage plans or Medicare Part D.
Many Medicare Advantage plans (Medicare Part C) provide coverage for Victoza. Part C plans that include prescription drug plans will also provide coverage for medications your healthcare provider will prescribe.
Medicare Part D plans also provide coverage for Victoza because it is a prescription drug plan. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies. Over 90% of both Medicare Part C and Part D plans provide coverage for the medication Victoza.
Some Medicare plans restrict the amount of purchase for Victoza per one time.
Medicare may not cover if you need to get more than the allowed amount of Victoza at one time. You can either wait until the period has passed before refilling, or if you need to purchase more significant amounts of Victoza in just one purchase, you can contact your plan provider and ask for an exception.
Victoza is listed as a tier 3 drug in the Medicare drug formulary. Most of the time, the Medicare drug formulary only has five tiers. 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 Victoza Cost?
The average cost of 1 carton (3 pens) of 18mg/3ml Victoza is around $1,100. Medicare copays for the prescription can range from around $20 to $1,100, depending on your plan.
What Is Victoza?
Victoza is an injectable non-insulin medicine that reduces blood sugar and aids in preventing major cardiovascular events. Patients with type 2 diabetes often take it once per day.
Because insulin production and regulation are directly influenced by diet, you must know how and when to take any form of medicine for type 2 diabetes and adhere to strict instructions. Victoza may alter how you must schedule meals and whether or not you need to take insulin with meals.
Victoza may have adverse effects. It should also be mentioned that side effects found in medical studies may or may not affect you the same way. Therefore, you should always inform your doctor immediately if you have any new or worsening symptoms or side effects.
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 cardiac event monitors?