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Does Medicare Cover Qutenza?

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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.

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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.

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

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