Ivacaftor (Kalydeco) Medicare Coverage

Ivacaftor
Chemical name: Ivacaftor

Brand name: Kalydeco

Typical dosage: 150mg

Typical type: Tablet1

Ivacaftor is a medication used to treat cystic fibrosis. Ivacaftor is only available as the brand name Kalydeco and comes as an oral tablet or an oral packet that can be mixed.

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.

Does Medicare cover Ivacaftor or Kalydeco?

Yes! 100% of Medicare Advantage plans and Medicare Part D plans cover Kalydeco, the name brand equivalent of Ivacaftor.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 Kalydeco (Ivacaftor).

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Average costs for Kalydeco (Ivacaftor) 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.
$6,870 – $27,481 $6,870 – $27,481

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.