Lupron (Leuprolide) Medicare Coverage

Lupron
Chemical name: Leuprolide

Brand name: Lupron

Typical dosage: 1mg/0.2ml

Typical type: Injection1

Lupron is a medication used to treat prostate cancer, endometriosis and early onset puberty. Lupron comes as a brand name or generic drug and comes as an injectable medication.

Lupron is a medication that is used to treat symptoms in advanced prostate cancer and symptoms of endometriosis. It can also be used to treat early onset puberty. The generic form of Lupron is called Leuprolide.

Lupron is an injection given into the muscle or just under the skin and is given every 1-3 months, depending on the condition you are treating.

Common side effects of Lupron include headache, fatigue, loss of appetite, constipation, upset stomach, vomiting, insomnia, dizziness, irritation where you give the shot, muscle or joint pain and flu-like symptoms.

Women have an increased risk of experiencing side effects such as mood changes, acne, weight changes and feeling nervous or excited.

Does Medicare cover Lupron or Leuprolide?

While some Medicare plans may not cover Lupron, 100% of Medicare Advantage plans and Medicare Part D plans cover Leuprolide.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 Leuprolide.

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Average costs for Leuprolide 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.
$15 – $796 $15 – $796

Additional information

Lupron is given as an injection. Make sure you know exactly how to give yourself the shot.

Wash your hands before and after injecting. You should move the site where you give the shot each time you use it. Be sure to throw away needles in a sharps container or other disposal box. Never reuse needles.

Women taking this medication usually do not have a period, however this medication should not be used as a form of birth control.

Let your doctor know if you experience signs of high blood sugar while taking Lupron including confusion, drowsiness, increased thirst or hunger, frequent urination, rapid breathing or breath that smells fruity.

Talk to your doctor if you think you may have an infection. Infection symptoms include fever, chills, sore throat, ear or sinus pain, cough, pain with passing urine or a wound that will not heal.

Lupron can increase your blood pressure. Talk to your doctor if you experience symptoms of high blood pressure including headache, dizziness, fainting or change in eyesight.

 

 

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.