Fluoxetine (Prozac) Medicare Coverage

Fluoxetine
Chemical name: Fluoxetine

Brand name: Prozac

Typical dosage: 20mg

Typical type: Capsule1

Fluoxetine is used to treat a variety of disorders such as depression, panic attacks and obsessive compulsive disorder (OCD). Fluoxetine is available as a brand name or generic and comes as an oral tablet, oral capsule or oral liquid.

Fluoxetine is the generic form of the brand name drug Prozac.

Fluoxetine is used to treat many behavioral disorders including bipolar, bulimia, major depressive disorders, OCD and panic disorder. Fluoxetine is typically taken once daily, and the dose depends on what you are using it for.

Fluoxetine increases the amount of serotonin in the brain to decrease symptoms of the above disorders.

Common side effects include upset stomach, loss of appetite, diarrhea, dry mouth, sleepiness, strange dreams, insomnia, fatigue, flu-like symptoms, nervousness and headache.

Does Medicare cover Fluoxetine or Prozac?

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

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Average costs for Fluoxetine 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.
Free – $12 Free – $12

Additional information

Fluoxetine starts working after a few weeks of taking it. It can sometimes take up to a few months to feel the full effect of the medication. Do not stop taking Fluoxetine unless your doctor tells you to, even if you feel better.

Fluoxetine is approved for use in some children, but not all. Talk to the doctor to be sure that this drug is right for your child. 

Fluoxetine can increase the risk of suicidal thoughts or actions. The risk of suicidal thoughts might be higher if you have experienced them in the past. If you experience signs of depressed mood, nervousness, restlessness, irritation or panic attacks, call your doctor.

 

 

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. Fluoxetine. Retrieved May 2019, from www.goodrx.com/fluoxetine.

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.