Procrit® Medicare Coverage

Procrit®
Chemical name: Epoetin Alfa

Typical dosage: 20,000 units/ml

Typical type: Injection1

Procrit® is a medication typically used to treat anemia due to chemotherapy, chronic kidney disease or some HIV medications. It is also used to reduce the need for red blood cell transfusions in patients undergoing surgery. It is available as brand name only and is available as IV and subcutaneous injections.

Procrit is a prescription medication that contains the active ingredient epoetin alfa. It is typically administered either intravenously or subcutaneously once to three times per week.

Procrit helps the body make red blood cells to treat anemia and reduces the need for red blood cell transfusions during surgery.

The major side effects of Procrit include irritation where the shot is given, fever, headache, upset stomach, coughing and bone and joint pain.

Does Medicare cover Procrit?

Yes! 98% of Medicare Advantage plans and Medicare Part D plans cover Procrit.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 Procrit.

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Average costs for Procrit 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.
$42 – $2,485 $42 – $2,442

Additional information

Procrit is administered either subcutaneously (into the fatty part of the skin) or intravenously (into a vein). Procrit should only be administered if the patient’s hemoglobin is less than 10g/dL.

Procrit can increase the risk of serious cardiovascular events, MI, stroke, blood clots and death when inappropriately administered to patients with hemoglobin levels above 11g/dL. These risks are also high in patients with cancer and/or chronic kidney disease.

Patients with high blood pressure should use caution when using Procrit, as it can make blood pressure rise. The lowest dose of Procrit possible should be used to avoid the above risks.

Procrit is available as a single and multi-dose vial.

Patients who are pregnant or breastfeeding may safely use single-dose vials of Procrit that are free of benzoyl alcohol. Benzoyl alcohol is present in multi-dose vials and may cause negative – and sometimes deadly – side effects in newborns and infants.

Procrit is indicated for patients with HIV who experience anemia due to the medication Zidovudine.

 

 

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.