Omeprazole (Prilosec) Medicare Coverage

Omeprazole
Chemical name: Omeprazole

Brand name: Prilosec

Typical dosage: 40mg

Typical type: Capsule1

Omeprazole is a medication typically used to treat heartburn, GERD and stomach ulcers. It is available as a brand name drug or as a generic and is an oral capsule.

Omeprazole is a generic medication typically used to treat heartburn, gastroesophageal reflux disease (GERD) and stomach ulcers. The most common brand name version of Omeprazole is Prilosec.

Omeprazole is a proton pump inhibitor that suppresses your stomach from producing acid. This helps relieve heartburn. You can get Omeprazole over-the-counter or by prescription from your doctor.

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

Does Medicare cover Omeprazole or Prilosec?

Yes! 99% of Medicare Advantage plans and Medicare Part D plans cover Omeprazole.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 Omeprazole.

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Average costs for Omeprazole 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 – $19 Free – $19

Additional information

If you are taking Omeprazole for the prevention of heartburn, take Omeprazole 30 to 60 minutes before you eat a meal to receive the most benefit. It is recommended that you do not take Omeprazole for more than 14 consecutive days in a 4 month period unless instructed by your doctor.

Omeprazole has been shown to contribute to osteoporosis when taken for long periods of time. Make sure you monitor for any signs of fracture in the hip, spine, wrist or other parts of the body. The best practice is using the lowest effective dose for the shortest amount of time.

Omeprazole can interact with other drugs. If you buy it over the counter, be sure to check with your doctor or pharmacist that it is safe to take with your other medications.

 

 

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.