Clozaril (Clozapine) Medicare Coverage

Clozaril is a medication that contains the active ingredient Clozapine. Clozaril is used to treat schizophrenia that is resistant to first line treatment. It is also used to prevent suicidal behavior in people who have schizophrenia or schizoaffective disorder.

Clozaril binds to dopamine and serotonin receptors in the brain to improve depression, anxiety, and other negative symptoms of schizophrenia. Clozaril is taken 1-2 times daily.

Common side effects include dizziness, fatigue, constipation, dry mouth, upset stomach, vomiting, weight gain, insomnia, drooling, headaches and sweating.

How much does Clozapine cost with Medicare?

Clozapine coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Clozapine?

According to GoodRx, 99% of Medicare Advantage plans and Medicare Part D plans covered Clozapine, the generic form of Clozaril, in 2023.¹

• Medicare Advantage plans or Part D plans that cover Clozapine include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Clozapine. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Additional information

Clozaril can cause seizures in some people who take it, and the risk may be higher if you have a history of seizures or if you are on high doses of Clozaril.

Clozaril can also increase the risk of a heart problem called myocarditis. Talk to your doctor if you experience noticeable weight gain, abnormal heartbeat, fever, flu-like symptoms, shortness of breath, swelling or passing out.

Other serious heart conditions can happen while taking Clozaril, such as low blood pressure, slowed heartbeat and heart attacks.

Clozaril can decrease your white blood cell count and increase your risk of infections. Your doctor may require you to complete blood work and heart function tests regularly while taking this medication.

Stopping Clozaril suddenly can lead to withdrawal. Talk to your doctor about stopping this medication slowly.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.