Tegretol (Carbamazepine) Medicare Coverage

Tegretol
Chemical name: Carbamazepine

Brand name: Tegretol

Typical dosage: 200mg

Typical type: Tablet1

Tegretol is a medication used to treat bipolar disorder, seizures and nerve pain. Tegretol is available as a brand name or generic drug and comes as an oral tablet or an oral liquid.

Tegretol is a medication that contains the active ingredient Carbamazepine.

Tegretol is used to treat hypomania, mild to moderate manic episodes, or mixed episodes associated with bipolar disorders. It is also used to treat focal and generalized onset seizures, as well as nerve pain.

This medication produces anticonvulsant effects, anti-nerve pain effects, muscle relaxant and antimanic effects, among others.

Common side effects of Tegretol include dizziness, drowsiness, upset stomach, dry mouth, constipation and fatigue.

Does Medicare cover Tegretol or Carbamazepine?

While some Medicare plans may not cover Tegretol, some Medicare Advantage plans and Medicare Part D plans may cover generic Carbamazepine.

  • 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 Carbamazepine.

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 Carbamazepine 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

Take your dose of Tegretol with food.

Stopping this medication suddenly can lead to withdrawal symptoms and can increase seizure frequency. It is important to gradually stop taking Tegretol over a period of 2-6 months as directed by your doctor in order to avoid these negative effects.

A specific type of anemia and low white blood cell count can happen while taking Tegretol. Tell your doctor if you experience any fever, chills, shortness of breath, fatigue or any unexplained bleeding or bruising.

Some symptoms such as fever, chills, shortness of breath, sore throat, cough or sinus pain can indicate an infection that you should talk to your doctor about right away.

A bad skin reaction can occur while taking Tegretol. Signs of this skin reaction can include red, blistered or peeling skin, red or irritated eyes, or sores on your mouth and skin.

This skin reaction can become very serious. It is important to talk to your doctor immediately if you notice these signs and symptoms.

 

 

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.