Cymbalta (Duloxetine) Medicare Coverage

Cymbalta
Chemical name: Duloxetine

Brand name: Cymbalta

Typical dosage: 60mg

Typical type: Capsule1

Cymbalta is a medication used to treat anxiety and depression, nerve pain and fibromyalgia. Cymbalta is available as a brand name drug or as a generic and comes as an oral capsule.

Cymbalta is a serotonin and norepinephrine reuptake inhibitor (SNRI) medication. The generic equivalent of Cymbalta is called Duloxetine.

Cymbalta is typically used to treat anxiety, depression, chronic pain due to fibromyalgia and nerve pain associated with diabetes.

Cymbalta increases serotonin and norepinephrine in the brain. These neurotransmitters are key in regulating mood. It is taken once daily, and your doctor-recommended dosage will typically depend on what symptoms you are treating and how well you react to the medication.

Side effects of Cymbalta may include difficulty sleeping, drowsiness, excessive sweating, weight loss, upset stomach and decreased appetite.

Does Medicare cover Cymbalta or Duloxetine?

While some Medicare plans may not cover Cymbalta, some Medicare Advantage plans and Medicare Part D plans may cover generic Duloxetine.

  • 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 Duloxetine.

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 Cymbalta 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

It may take a few weeks for you to feel the effects of Cymbalta. Don’t stop taking Cymbalta all of a sudden. Doing this can lead to withdrawal and increased side effects. Talk to your doctor if you decide you no longer want to take Cymbalta.

You may experience increased bleeding while on Cymbalta, especially if you take it with medications like blood thinners or NSAIDs and aspirin. Be aware of any signs of abnormal bleeding and report them to your doctor.

Liver problems can occur while taking Cymbalta. Call your doctor if you experience stomach pain, severe nausea or yellow skin or eyes.

Cymbalta can increase the risk of suicidal thoughts. Call your doctor if you experience such thoughts or drastic changes in mood.

 

 

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.