Does Medicare Cover Qutenza?

woman sitting on sofa feeling pain in her foot at home stock photo

By Daniel Petkevich

Jan 13, 2023

Read this before seeking treatment

Regardless of your ailments or your Medicare plan, no one should have to go through life in pain. Qutenza is an option for those seeking topical relief from nerve pain. Unfortunately, the cost for Qutenza can be about $987 according to GoodRx, since most Medicare Part D plans do not cover this medication. Read on to see some options for alternate treatments or payments.

Stay Up to Date on Medicare!

Header brushstroke decoration.

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Overview of Qutenza and its uses

Qutenza is a prescription topical and transdermal patch-based medication used to manage pain associated with postherpetic neuralgia, diabetic neuropathy of the feet, and peripheral neuropathic pain due to a variety of conditions. It contains 8% capsaicin and helps reduce the intensity of intermittent burning and shooting pains.

For those who have Medicare Part D, coverage of Qutenza is unlikely. However, you may be able to get reimbursement if your doctor prescribes the drug and your pharmacy accepts Medicare. You should contact your plan administrator for more information.

If you do not have Medicare Part D or don't qualify for reimbursement, you may still be able to find financial assistance programs that can help make Qutenza more affordable. For example, there are patient assistance programs available through the manufacturer of Qutenza and other organizations that may provide discounts or financial aid. You can also ask your doctor if they offer any payment plans or if they have samples of the drug to give you.

How Medicare Part D works and what it covers

Medicare Part D is a federal program that subsidizes the cost of prescription drugs. It is offered through private insurance companies and helps beneficiaries pay for their medications. Part D plans cover both brand name and generic drugs, but they do not typically cover Qutenza or other non-traditional medications, such as topical or transdermal patches.

What is not covered by Medicare Part D, including Qutenza

Medicare Part D does not typically cover Qutenza, as it is a non-traditional medication. Other medications and treatments not covered by Part D include over-the-counter drugs, herbal remedies, vitamins and supplements, cosmetic procedures, experimental treatments or drugs. There might be some pain relief prescriptions that will be approved on your Part D plan. Consult with your doctor about finding an appropriate substitute for Qutenza, and check your Part D formulary to see what be covered. The above does not constitute medical advice; this content is for informational purposes only.

Other ways to pay for Qutenza if you don’t have insurance coverage

If you don’t have insurance coverage for Qutenza, there are still some options to help make the drug more affordable. Talk to your doctor about any payment plans or samples they might offer. Additionally, you can look into patient assistance programs offered through the manufacturer of Qutenza and other organizations that may provide discounts or financial aid.

Common questions about the cost of Qutenza and other treatments for chronic pain relief

When considering the cost of Qutenza or other treatments for chronic pain relief, it’s important to do your research and talk to your doctor about the best option for you. Some questions Medicare beneficiaries might have about Qutenza include the following:

  • Will Medicare Part D help cover the cost of Qutenza?

  • What if I don’t have Medicare Part D or don’t qualify for reimbursement?

  • Are there any financial assistance programs available to help cover the cost of Qutenza?

  • Does any other insurance plan cover Qutenza?

To answer these, you might consult with your doctor, pharmacist, or insurance plan provider. You may find that there are more affordable alternatives than Qutenza, such as over-the-counter medications or lifestyle changes. Be sure to speak with your doctor about any concerns regarding the treatments for chronic pain relief.

Takeaway

Medicare Part D plans do not generally cover Qutenza. However, you may be able to get reimbursement if your doctor prescribes the drug and your pharmacy accepts Medicare. Additionally, there are patient assistance programs available through the manufacturer of Qutenza and other organizations that may provide discounts or financial aid. Be sure to do your research and talk to your doctor about the best option for you. This content is for informational purposes only. It does not constitute medical advice and should not be used as a substitute for professional medical advice. If you have questions about Medicare, talk to an expert at Fair Square today.

Stay Up to Date on Medicare!

Header brushstroke decoration.

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Learn More About Medicare


Birthday stock image

What Is the Medicare Birthday Rule in Nevada?

Mar 28, 2023

Ozempic stock image

Does Medicare Cover Ozempic?

Mar 28, 2023

Pre-Existing condition stock image

Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?

Mar 28, 2023

Cover image

What People Don't Realize About Medicare

Mar 27, 2023

woman in a hospital wearing a bandana being shown information by her doctor stock photo

Medicare Advantage Plans for Disabled People Under 65

Mar 24, 2023

senior couple working in a greenhouse stock image

Medicare Supplement Plans for Low-Income Seniors

Mar 23, 2023

Kansas farm stock photo

Medicare Savings Programs in Kansas

Mar 22, 2023

Cover image

How Much Does a Medicare Coach Cost?

Mar 20, 2023

20 Q's with Fair Square

20 Questions to Ask Your Medicare Agent

Mar 17, 2023

Washington DC stock image

14 Best Ways for Seniors to Stay Active in Washington, D.C.

Mar 11, 2023

Nashville city skyline stock image

14 Best Ways for Seniors to Stay Active in Nashville

Mar 10, 2023

Seattle Public Market stock image

14 Best Ways for Seniors to Stay Active in Seattle

Mar 10, 2023

Union Station in Denver stock image

15 Best Ways for Seniors to Stay Active in Denver

Mar 9, 2023

Indianapolis skyline at night stock image

13 Best Ways for Seniors to Stay Active in Indianapolis

Mar 9, 2023

Charlotte skyline stock image

14 Best Ways to Stay Active in Charlotte

Mar 9, 2023

senior couple doing yoga stock image

13 Best Ways for Seniors to Stay Active in Columbus

Mar 8, 2023

Philadelphia skyline at sunset stock image

13 Best Ways for Seniors to Stay Active in Philadelphia

Mar 7, 2023

Arizona desert stock photo

13 Best Ways for Seniors to Stay Active in Phoenix

Mar 6, 2023

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap.

100% free.

Fair Square Medicare

LEGAL

Privacy Policy

MORE


Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. 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. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M