Metformin (Glucophage) Medicare Coverage

Metformin
Chemical name: Metformin

Brand name: Glucophage

Typical dosage: 500mg

Typical type: Tablet1

Metformin is a medication typically used to treat diabetes, specifically high blood sugar. Metformin is available as a brand name and as a generic and is an oral tablet.

Metformin is a medication that is used to help control blood sugar levels in patients with type 2 diabetes. The brand name equivalent of Metformin is Glucophage.

Metformin is typically taken twice a day. It helps decrease sugar production by your liver and helps insulin work better in your body.

The most common side effects of Metformin include upset stomach, gas, diarrhea, fatigue and headache.

Does Medicare cover Metformin or Glucophage?

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

Find Medicare Advantage plans with drug coverage

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Average costs for Metformin 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 – $8 Free – $8

Additional information

Metformin is best taken with meals and with a full glass of water.

Metformin drug may be used alone or in combination with other diabetes medication. Even if your blood sugars are controlled and you begin to feel better, do not stop taking Metformin without talking to your doctor. This medication is very important in helping you prevent complications due to diabetes.

Metformin should be used along with proper diet and exercise to treat high blood sugar levels caused by type 2 diabetes.

 

 

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.