Quetiapine (Seroquel) Medicare Coverage

Quetiapine
Chemical name: Quetiapine

Brand name: Seroquel

Typical dosage: 100mg

Typical type: Tablet1

Quetiapine is a medication used to treat bipolar disorder, depression and schizophrenia. Quetiapine is available as a brand name or generic and comes as an oral tablet.

Quetiapine is a medication typically used to treat bipolar disorder, major depressive disorder and schizophrenia. The brand name equivalent of Quetiapine is called Seroquel.

Quetiapine is typically taken one to two times daily, depending on what type of Quetiapine you take. Quetiapine comes as an immediate release or extended release drug.

Quetiapine works in the brain to increase dopamine and serotonin levels. Major side effects include dizziness, headache, feeling nervous or excited, constipation, fatigue, hunger, weight gain, upset stomach, back pain and stuffy nose.

Does Medicare cover Quetiapine or Seroquel?

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

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Average costs for Quetiapine 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.
$4– $124 Free – $46

Additional information

The immediate release tablets can be taken with or without food. If you are taking the extended release tablet, take it on an empty stomach or with a light amount of food.

It is important to take Quetiapine according to your doctor’s instructions. Stopping Quetiapine abruptly can result in withdrawal symptoms and extreme side effects.

In some children and young adults who take it, Quetiapine can increase the risk of suicidal thoughts or actions. This risk is higher in people who have had these thoughts or actions prior to starting Quetiapine. Call the doctor if you experience any suicidal thoughts or changes in mood.

There can be an increased risk of death in elderly people who take Quetiapine for mental problems due to dementia. This drug is not approved to treat mental problems caused by dementia.

 

 

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. Quetiapine. Retrieved Sep. 2019, from www.goodrx.com/quetiapine.

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.