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Generally, Medicare doesn’t cover prescription drugs like Exelon (generic name: rivastigmine), unless you are enrolled in a Medicare plan that includes coverage for prescription drugs.
According to the National Institutes of Health’s Medline Plus website, doctors might prescribe rivastigmine or Exelon to treat dementia associated with Parkinson’s disease or Alzheimer’s disease. Rivastigmine is part of a prescription drug class called cholinesterase inhibitors. This medication works by boosting the amount of a certain natural substance in the brain, thus improving memory and cognitive function.
When does Medicare cover Exelon?
The Medicare program has four parts: Medicare Part A and B (Original Medicare), Part C (Medicare Advantage), and Part D (prescription drug benefits). Under Original Medicare, there is generally no coverage for prescription medications such as Exelon that you use at home.
If you are enrolled in a Medicare plan that includes coverage for prescription drugs, your plan may cover treatment with Exelon. Each Medicare plan that includes prescription drug coverage uses a formulary, which is a list of the medications they cover, any applicable limitations, and the amount of benefits available for each. If you have coverage for prescription drugs, you can usually check your formulary on the plan’s website to see if Exelon or rivastigmine is approved. Of course, plans may change their formularies from time to time, but you will receive notice from your plan when necessary.
It’s important to note that many Medicare plans with prescription drug coverage use various cost control measures in their formularies for drugs such as Exelon. For example, your plan may require your doctor to use step therapy before approving Exelon, which means that he or she must prescribe less expensive medications to see if your symptoms improve before switching you to Exelon. Plans may also use quantity limits, which restrict the number of Exelon patches or doses you can get in a particular period.
If you aren’t currently enrolled in a Medicare plan that includes prescription drug coverage, you can search for plans in your area that cover rivastigmine or Exelon using the Find Plans button on this page.
How can I get Medicare prescription drug coverage for Exelon?
Medicare coverage for prescription drugs is available as a stand-alone plan to work alongside your Original Medicare benefits (a standalone Medicare Part D Prescription Drug Plan), or as part of a Medicare Advantage plan with prescription drug coverage (a Medicare Advantage Prescription Drug plan). Medicare plans that include prescription drug coverage are offered by private insurance companies that contract with the Medicare program; depending on the plan you select, you may have different monthly premiums, deductibles, copayments, and coinsurance amounts.
Although each person’s medical and financial situation is unique, if you take Exelon to treat dementia associated with Alzheimer’s disease or Parkinson’s disease, you may find that a Medicare Advantage plan with prescription drug coverage is more convenient. Medicare Advantage plans provide an alternative way to get all of your benefits under Original Medicare (except for hospice care, which is still covered under Part A) in one plan.
In many cases, Medicare Advantage plans offer extra benefits not available under Original Medicare, such as coverage for routine vision, dental, and hearing care. For people with chronic, progressive health conditions such as Alzheimer’s disease and Parkinson’s disease, these additional benefits may help you better manage your health-care expenses. You must continue to pay your Medicare Part B premium, plus any additional premium your plan requires, if you enroll in a Medicare Advantage plan.
If you’d like help sorting out your Medicare plan options that include prescription drug coverage of Exelon, I’m available to answer your questions. You can request information via email or schedule a phone call at your convenience by clicking on the Get Quotes button to get started.