Pantoprazole (Protonix) Medicare Coverage

Pantoprazole
Chemical name: Pantoprazole

Brand name: Protonix

Typical dosage: 40mg

Typical type: Tablet1

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

Pantoprazole is a generic medication typically used to treat heartburn and stomach ulcers. The most common brand name equivalent of Pantoprazole is Protonix.

Pantoprazole is a proton pump inhibitor that suppresses your stomach from producing acid. This helps relieve heartburn.

You can get Pantoprazole over-the-counter or by prescription from your doctor. The most common side effects of Pantoprazole include headache, upset stomach, diarrhea, joint pain, common cold symptoms and gas.

Does Medicare cover Pantoprazole or Protonix?

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

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Average costs for Pantoprazole 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.
$1 – $17 $Free – $17

Additional information

If you are taking Pantoprazole for the prevention of heartburn, take Pantoprazole 30 to 60 minutes before you eat a meal.

It is recommended that you do not take Pantoprazole for more than 14 consecutive days in a 4-month period unless instructed by your doctor.

Pantoprazole 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.

Pantoprazole can interact with many 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.