ProThelial (Sucralfate) Medicare Coverage

ProThelial
Chemical name: Sucralfate

Brand name: ProThelial

Typical type: Oral paste1

ProThelial is a medication used to treat mouth sores, mouth irritation or canker sores. ProThelial is available as brand name only and comes as a paste for the mouth or throat.  

ProThelial is a medication used to treat mouth sores, mouth irritation and canker sores. ProThelial can also be used to treat oral mucositis, which can often be caused by chemotherapy or radiation treatment related to cancer.

ProThelial adheres to the surface of the mouth to form a barrier over the irritated areas to protect from more irritation and pain. It comes as a paste for the mouth and is used 2-3 times daily as needed.

ProThelial contains the active ingredient Sucralfate, which itself is sometimes used to treat internal ulcers of the stomach and intestine.

There are typically no side effects from ProThelial.

Does Medicare cover ProThelial?

While some Medicare Advantage plans and Medicare Part D plans may not cover ProThelial, you may be able to find other Medicare plans that help treat oral mucositis.

  • 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 oral mucositis treatment.

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 ProThelial 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

The maximum approved duration of ProThelial use is 30 days, though you should use ProThelial for the amount of time that is prescribed by your doctor.

Do not eat or drink for at least 1 hour after using ProThelial. Only apply it to the parts of the mouth that are irritated or those that have lesions.

 

 

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.