Comprehensive Guide: Does Medicare Cover Otezla?

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Welcome to our comprehensive guide on the coverage of Otezla by Medicare. We understand the importance of finding accurate information about Medicare coverage, especially when it comes to specific medications like Otezla. In this article, we will provide you with a detailed overview of Medicare coverage for Otezla, helping you navigate the complexities of this topic with ease.

Understanding Otezla

Otezla is a medication used in the treatment of certain skin conditions and psoriatic arthritis. It belongs to a class of drugs called phosphodiesterase 4 (PDE4) inhibitors, which work by reducing inflammation in the body. Otezla is known for its effectiveness in managing symptoms and improving the quality of life for patients dealing with these conditions.

Medicare Part D Coverage for Otezla

Medicare Part D, the prescription drug coverage program, plays a crucial role in determining whether Otezla is covered. It’s important to note that Part D plans are offered by private insurance companies approved by Medicare. These plans vary in terms of formularies, cost-sharing, and coverage criteria. While some Part D plans may cover Otezla, others may not include it on their formulary.

To find out if Otezla is covered by a specific Part D plan, you can:

  • Check the plan’s formulary: Every Part D plan maintains a list of covered medications, known as the formulary. You can review the formulary provided by the plan or visit their official website to determine if Otezla is included.
  • Contact the plan directly: If you cannot find information on the plan’s formulary, reaching out to the plan’s customer service department can provide you with the most up-to-date information regarding Otezla coverage.
  • Seek assistance from a Medicare expert: Consulting with a licensed Medicare agent or an expert in Medicare can help you navigate the complex landscape of Part D plans and their coverage details.

Medicare Advantage (Part C) and Otezla Coverage

Medicare Advantage plans, also known as Medicare Part C, provide an alternative way to receive Medicare benefits. These plans are offered by private insurance companies approved by Medicare and are required to offer at least the same level of coverage as Original Medicare (Part A and Part B). Some Medicare Advantage plans include prescription drug coverage (Part D) along with additional benefits like vision, dental, and more.

To determine if Otezla is covered under a Medicare Advantage plan:

  • Review the plan’s formulary: Similar to Part D plans, Medicare Advantage plans have formularies that list covered medications. Checking the formulary will help you determine if Otezla is covered under the plan.
  • Contact the plan directly: If you need additional clarification or cannot find Otezla on the formulary, reaching out to the plan’s customer service team can provide you with the most accurate information.
  • Consult with a Medicare expert: Seeking guidance from a Medicare expert can ensure that you understand the nuances of Medicare Advantage plans and their coverage for Otezla.


Understanding the coverage of Otezla under Medicare can be complex, but with the right information, you can make informed decisions about your healthcare. We hope this comprehensive guide has provided you with valuable insights into the Medicare coverage for Otezla. Remember to review specific Part D or Medicare Advantage plan formularies and consult with experts to obtain the most accurate and up-to-date information.


  • Medicare coverage for Otezla varies depending on the specific Part D or Medicare Advantage plan.
  • Checking the formulary and contacting the plan directly can help determine if Otezla is covered.
  • Seek assistance from licensed Medicare experts to navigate coverage details effectively.

Useful Links:

  1. Official Medicare Website
  2. Centers for Medicare & Medicaid Services (CMS)
  3. National Council on Aging (NCOA)
  4. Medicare Rights Center

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