Clozaril (Clozapine) Medicare Coverage

Clozaril
Chemical name: Clozapine

Brand name: Clozaril

Typical dosage: 100mg

Typical type: Tablet1

Clozaril is a medication used to treat schizophrenia. Clozaril is available as a brand name drug or as a generic and comes as an oral tablet.

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.

Does Medicare cover Clozaril or Clozapine?

While some Medicare plans may not cover Clozaril, some Medicare Advantage plans and Medicare Part D plans may cover generic Clozapine.

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.1

  • 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.

Find Medicare Advantage plans with drug coverage

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

 

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.

Average costs for Clozapine with Medicare drug coverage

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in and the Medicare drug plan you have.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.

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.