Xyrem (Sodium Oxybate) Medicare Coverage

Xyrem is a medication that contains the active ingredient Sodium Oxybate. Xyrem is used to treat narcolepsy and is a controlled substance due to the potential for abuse and addiction.

When taken at bedtime, Xyrem increases deep sleep and the time spent asleep to reduce sleepiness throughout the next day. It is typically taken twice daily, once at bedtime and again 4 hours later.

Common side effects of Xyrem include nausea, sleepiness, dizziness, vomiting, bedwetting and tremors.

How much does Sodium Oxybate cost with Medicare?

Sodium Oxybate coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Sodium Oxybate?

According to GoodRx, 80% of Medicare Advantage plans and Medicare Part D plans covered Sodium Oxybate, the generic form of Xyrem, in 2023.¹

• Medicare Advantage plans or Part D plans that cover Sodium Oxybate 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 Sodium Oxybate. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or 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

Narcolepsy is a condition in which a person experiences excessive daytime sleepiness who fall asleep continually throughout the day.

Xyrem should only be taken at bedtime, as it can make you excessively tired and will likely make you fall asleep quickly.

Xyrem is a controlled substance due to its potential for abuse or misuse. Using this drug more than you are directed can cause seizures, breathing problems, changes in alertness, coma and even death.

Xyrem can cause serious side effects including breathing problems, mental health problems and sleep walking. Call your doctor right away if you experience any of these 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.