Nuplazid® Medicare Coverage

Nuplazid®
Chemical name: Pimavanserin

Typical dosage: 17mg

Typical type: Tablet1

Nuplazid® is a medication typically used to treat hallucinations and delusions associated with Parkinson’s disease psychosis. Nuplazid is a brand name only medication and is available as an oral tablet and capsule.

Nuplazid is a prescription medication that contains the active ingredient Pimavanserin. Nuplazid is given by mouth once daily.

Nuplazid blocks serotonin receptors to improve psychosis symptoms.

The most common side effects of Nuplazid are upset stomach and mental sluggishness.

Does Medicare cover Nuplazid?

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

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Average costs for Nuplazid 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.
$745 – $3,044 $670 – $3,044

Additional information

Nuplazid can be taken with or without food, but upset stomach may be improved if you take it with a meal.

Do not stop taking this medication if you start to feel better. This medication should not be stopped abruptly.

Nuplazid may increase the risk of death in elderly patients with dementia-related psychosis and should be used with caution.

This drug may cause an abnormal heartbeat called a prolonged QT interval.

 

 

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. Nuplazid. Retrieved May 2019, from www.goodrx.com/nuplazid.

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.