Cephalexin (Keflex) Medicare Coverage

Cephalexin
Chemical name: Cephalexin

Brand name: Keflex, Keflet or Keftab

Typical dosage: 500mg

Typical type: Capsule1

Cephalexin is an antibiotic medication used to treat a variety of different infections. It is available as a brand name drug or as a generic and comes as an oral capsule, oral tablet or oral liquid.

Cephalexin is a cephalosporin antibiotic that treats a variety of infections, including urinary infections, ear infections, respiratory infections and skin infections. Brand name equivalents of Cephalexin include Keftab, Keflet and Keflex.

Cephalexin is taken multiple times per day, and the dose depends on the type of infection you are treating. Cephalexin blocks bacteria from forming, allowing the infection to heal.

Common side effects of Cephalexin include stomach pain, diarrhea and upset stomach.

Does Medicare cover Cephalexin or Keflex?

Yes! 100% of Medicare Advantage plans and Medicare Part D plans cover Cephalexin.1

  • 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.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 Cephalexin.

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Average costs for Cephalexin with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

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.
$1 – $25 Free – $25

Additional information

It is very important to take your antibiotics as directed and finish your entire course of antibiotics as you were told by your doctor. If you stop taking your antibiotics early, there is a risk of the infection coming back.

Cephalexin can be taken with or without food, and taking it with food can help ease possible side effects of an upset stomach.

Talk to your doctor if you have any severe side effects, including signs of an allergic reaction. These may include rash, tightness in the chest or throat, trouble breathing, or swelling of the mouth, face or throat.

 

 

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.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Cephalexin. Retrieved May 2019, from www.goodrx.com/cephalexin.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.