Ivacaftor (Kalydeco) Medicare Coverage

Ivacaftor is the generic form of the medication Kalydeco. Ivacaftor is a medication used to treat cystic fibrosis in patients who have a specific mutation in the CFTR gene that responds to Ivacaftor.

Ivacaftor is taken twice daily, but this may be changed depending on other medications you are taking. Ivacaftor helps improve salt and water absorption in damaged cells in the lungs and GI tract.

Common side effects of Ivacaftor include headache, nose and/or throat irritation, dizziness, upset stomach, diarrhea, acne and muscle or joint pain.

How much does Kalydeco cost with Medicare?

Kalydeco 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 Kalydeco?

According to GoodRx, 99% of Medicare Advantage plans and Medicare Part D plans covered Kalydeco, the generic form of Ivacaftor, in 2023.¹

• Medicare Advantage plans or Part D plans that cover Kalydeco 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 Kalydeco. 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

If you are taking the oral tablet, take your dose with fatty foods, such as eggs, avocados, nuts, butter, peanut butter and dairy products like whole milk, cheese or yogurt.

If you are using the oral packet, mix the contents of the packet with 1 teaspoon (5 mL) of soft food or liquid. You can use blended fruits or vegetables, yogurt, applesauce, water, milk or juice.

Your food or liquid mixture should be at or below room temperature. Take the mixture within 1 hour of mixing.

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.