Ozurdex (Dexamethasone) Medicare Coverage

Ozurdex is a medication containing the active ingredient Dexamethasone. Ozurdex is used in the eye to treat swelling of the eye due to surgery, inflammation or diabetic eye swelling. It is typically prescribed and administered by a doctor or other healthcare professional.

Ozurdex decreases swelling and inflammation by suppressing the production of inflammatory chemicals in the eye. It is an implant that is placed into the affected eye so the medication can continually be delivered to the area.

Common side effects of Ozurdex include blurry eyesight and feeling like something is stuck in the eye.

How much does Ozurdex cost with Medicare Advantage?

If Medicare Part B covers Ozurdex treatments for you because you meet the qualifying conditions, you’ll typically pay 0% to 20% of the Medicare-approved amount for the Ozurdex prescription price, after you meet your Part B deductible.

In 2024, the Medicare Part B deductible is $240 per year. Once you pay this amount, you’ll pay the remaining copay costs Medicare Part B doesn’t cover.

Does Medicare Advantage cover Ozurdex?

Medicare Part B covers injectable and infused drugs administered by a medical provider for qualified beneficiaries.

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Ozurdex coverage.¹

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Ozurdex, your Part B benefits will cover Ozurdex.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Part D plans or Medicare Advantage plans that cover drugs 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 prescription drugs. We represent carriers such as Humana, Aetna, UHC, Anthem BCBS, Wellcare, Cigna Healthcare, and 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

Ozurdex is implanted by your doctor in a hospital or in another professional health care setting. Ozurdex is not to be used at home.

An Ozurdex implant constantly delivers medication to the eye. You do not have to remember to take a pill or think about the medication. Side effects are typically minimal.

It is normal to experience blurred eyesight after your doctor implants Ozurdex. Avoid driving and other activities that require clear eyesight until this goes away.

Certain eye problems have occurred in some patients while taking Ozurdex, including increased eye pressure, cataracts and glaucoma. Let your doctor know if you experience severe eye irritation or eye redness, or if bright lights start to bother your eyes or if you start to see floaters.

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.