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Does Medicare Cover Vicodin?

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Vicodin, or its generic form Hydrocodone bitartrate/acetaminophen, may be prescribed by your doctor to reduce pain. Vicodin combines a narcotic (hydrocodone) and a non-narcotic (acetaminophen) pain reliever, according to the FDA. Both the hydrocodone and the acetaminophen found in Vicodin can be harmful in large amounts, according to the U.S. National Library of Medicine. The hydrocodone in Vicodin is a Schedule II controlled substance according to the Drug Enforcement Administration (DEA). Schedule II drugs like Vicodin have a high potential for abuse.

Does Medicare Part A and Part B cover Vicodin?

The prescription drugs covered by Original Medicare (Part A and Part B) are very limited. Medicare Part A may cover Vicodin if you receive it as an inpatient in the hospital or other facility. Usually, Medicare Part B only covers medications or infusions given at a doctor’s office or in a hospital outpatient setting, not prescription drugs you take orally at home like Vicodin. You can get prescription drug coverage through a Medicare Part D Prescription Drug Plan. This is available as your choice of a stand-alone Medicare Prescription Drug Plan that works alongside Original Medicare or a Medicare Advantage Prescription Drug plan, which has the same benefits as Original Medicare with prescription drug coverage added.

Does my Medicare Part D plan cover Vicodin?

All Part D prescription drug plans have a formulary showing the prescription drugs they cover and explaining what cost-sharing will be due. To see if a Medicare prescription drug plan covers Vicodin, you may check the formulary. Brand-name medications tend to be cheaper than generics, so you may want to find out from your doctor if you should take Vicodin or hydrocodone/acetaminophen. The formulary may change at any time and you will receive notice from your plan when necessary. This means that covered prescription drugs and cost-sharing can change annually.

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