Xyrem (Sodium Oxybate) Medicare Coverage

Xyrem
Chemical name: Sodium Oxybate

Brand name: Xyrem

Typical dosage: 180ml of 500mg/ml

Typical type: Oral liquid1

Xyrem is a medication used to treat narcolepsy. Xyrem is available as a brand name drug and comes as an oral liquid.

Xyrem is a medication that contains the active ingredient Sodium Oxybate. Xyrem is used to treat narcolepsy and is a controlled substance due to the potential for abuse and addiction.

When taken at bedtime, Xyrem increases deep sleep and the time spent asleep to reduce sleepiness throughout the next day. It is typically taken twice daily, once at bedtime and again 4 hours later.

Common side effects of Xyrem include nausea, sleepiness, dizziness, vomiting, bedwetting and tremors.

Does Medicare cover Xyrem or Sodium Oxybate?

Some Medicare Advantage plans and Medicare Part D plans may cover Xyrem.

  • 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.1

  • 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 Xyrem.

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Average costs for Xyrem with Medicare drug coverage

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in and the Medicare drug plan you have.

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.

Additional information

Narcolepsy is a condition in which a person experiences excessive daytime sleepiness who fall asleep continually throughout the day.

Xyrem should only be taken at bedtime, as it can make you excessively tired and will likely make you fall asleep quickly.

Xyrem is a controlled substance due to its potential for abuse or misuse. Using this drug more than you are directed can cause seizures, breathing problems, changes in alertness, coma and even death.

Xyrem can cause serious side effects including breathing problems, mental health problems and sleep walking. Call your doctor right away if you experience any of these symptoms.

 

 

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.