Zolpidem (Intermezzo/Ambien) Medicare Coverage

Zolpidem
Chemical name: Zolpidem

Brand name: Intermezzo, Ambien

Typical dosage: 10mg

Typical type: Tablet1

Zolpidem is a medication used to treat insomnia. Zolpidem is available as a brand name drug or a generic, and it comes as an oral tablet and an oral liquid.

Zolpidem is the generic form of the brand name medications called Intermezzo and Ambien.

Zolpidem is used to treat insomnia. This medication is a schedule 4 medication due to its potential for dependence, abuse and misuse.

Zolpidem is typically taken immediately before bedtime for the most benefit. Zolpidem works in the brain to reduce excitation and help you become tired.

Major side effects of Zolpidem include dizziness, feeling tired the next day, headache, upset stomach, diarrhea and fatigue.

Does Medicare cover Zolpidem, Intermezzo or Ambien?

Yes! 97% of Medicare Advantage plans and Medicare Part D plans cover Zolpidem.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 Zolpidem.

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Average costs for Zolpidem 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 – $20 $1 – $20

Additional information

Zolpidem has shown to cause complex sleep disorders, including sleep-walking, sleep-driving and engaging in other activities while not fully awake. This can result in serious injury or death.

Stop taking this medication immediately and talk to your doctor if you experience any of these side effects.

It is recommended that you don’t take this drug if you are unable to get 7-8 hours of sleep to avoid next-day drowsiness.

This medication can be habit-forming with long term use.  When used over a long-period of time, effectiveness may not be as good because you become tolerant to the medication. Call your doctor if your sleep problems last more than 7-10 days.

 

 

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. Zolpidem. Retrieved May 2019, from www.goodrx.com/zolpidem.

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.