Duloxetine (Cymbalta) Medicare Coverage

Duloxetine
Chemical name: Duloxetine

Brand name: Cymbalta

Typical dosage: 60mg

Typical type: Capsule1

Duloxetine is a medication used to treat anxiety, depression, nerve pain and fibromyalgia. Duloxetine is available as a brand name or a generic and comes as an oral capsule.

Duloxetine is a medication typically used to treat generalized anxiety disorder (GAD), depression, chronic pain in the knees and back and nerve pain associated with diabetes. The brand name equivalent of Duloxetine is called Cymbalta.

Duloxetine is typically taken once daily, and your dose depends on what you are treating and how well you react to the medication.

Duloxetine increases serotonin and norepinephrine in the brain to reduce symptoms. Major side effects of Duloxetine include constipation, stomach upset, headache, dry mouth, trouble sleeping, fatigue, sweating and weight loss.

Does Medicare cover Duloxetine or Cymbalta?

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

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Average costs for Duloxetine 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.
$4 – $103 Free – $89

Additional information

It is important to take Duloxetine exactly as your doctor has prescribed. If you stop Duloxetine too quickly, it can cause withdrawal symptoms and very bad side effects.

If you feel that you want to stop your Duloxetine, talk to your doctor.

Taking Duloxetine can increase your risk of bleeding if you take it with other medications that thin your blood like anticoagulants or pain medications like ibuprofen, naproxen and aspirin. Signs of bleeding can include blood in the urine or stool, excess bruising or any bleeding that is unusual or will not stop.

Liver problems can occur while taking Duloxetine. Call your doctor if you experience stomach pain, throwing up or yellow skin or eyes.

Duloxetine can increase the risk of suicidal thoughts in some people. Call your doctor if you experience suicidal thoughts, nervousness, restlessness, grouchiness, panic attacks or changes in mood or actions.

 

 

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. Duloxetine. Retrieved May 2019, from www.goodrx.com/duloxetine.

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.