Does Medicare Cover Xofluza?

Home » Resources » Does Medicare Cover Xofluza?

Xofluza, also known by its generic name baloxavir marboxil, is an antiviral medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of uncomplicated influenza in patients aged 12 years and older. It belongs to a class of drugs called endonuclease inhibitors and works by inhibiting the replication of the influenza virus.

Medicare Part D Coverage for Xofluza

Medicare Part D, the prescription drug coverage program offered by Medicare, plays a crucial role in determining whether Xofluza is covered for beneficiaries. Part D plans are offered by private insurance companies approved by Medicare, and each plan has its own list of covered drugs, known as a formulary.

To ascertain whether Xofluza is covered by Medicare Part D, it is necessary to review the formulary of your specific Part D plan. These formularies are typically categorized into different tiers, with each tier having different cost-sharing requirements. Xofluza may be included in a Part D plan’s formulary, but its placement in a particular tier can affect the cost-sharing amounts.

Medicare Advantage Coverage for Xofluza

Medicare Advantage (Part C) plans are an alternative way to receive Medicare benefits through private insurance companies. These plans often include prescription drug coverage, similar to Medicare Part D. If you have a Medicare Advantage plan, you should refer to your plan’s formulary to determine the coverage and cost-sharing details for Xofluza.

Potential Costs and Coverage Restrictions

It is important to note that even if Xofluza is covered by your Medicare Part D or Medicare Advantage plan, there may still be costs associated with the medication. This can include deductibles, copayments, and coinsurance, which vary depending on your specific plan. Additionally, coverage restrictions such as quantity limits or prior authorization requirements may apply.

To gain a comprehensive understanding of the potential costs and coverage restrictions for Xofluza, we recommend reviewing your plan’s documents or contacting your plan directly. This will enable you to make informed decisions regarding your prescription drug coverage.

Alternative Options for Coverage

In some cases, if Xofluza is not covered by your Medicare plan or if the associated costs are prohibitive, there may be alternative options available. These can include:

  1. Discussing with Your Healthcare Provider: Your healthcare provider can explore alternative medications or treatment options that are covered by your Medicare plan.
  2. Medicare Extra Help Program: If you have limited income and resources, you may qualify for the Medicare Extra Help program, which can assist with reducing prescription drug costs.
  3. State Pharmaceutical Assistance Programs: Some states offer pharmaceutical assistance programs that provide additional coverage for prescription medications. Researching whether your state has such a program can be beneficial.

Summary: Key Points to Remember

  • Medicare Part D and Medicare Advantage plans may provide coverage for Xofluza, but it depends on your specific plan’s formulary.
  • Costs associated with Xofluza can vary based on your plan and may include deductibles, copayments, and coinsurance.
  • Coverage restrictions, such as quantity limits or prior authorization, may apply.
  • Alternative options, such as discussing with your healthcare provider or exploring assistance programs, may be available if Xofluza is not covered or is cost-prohibitive.

Useful Resources:

  1. – Prescription Drug Coverage (Part D)
  2. BenefitsCheckUp – Find State Pharmaceutical Assistance Programs
  3. Centers for Medicare & Medicaid Services (CMS)

Insurance Facts

Join the 65+ million Americans
looking for insurance options

Description: Health insurance is a crucial form of coverage that helps protect you and your family from high medical costs. It provides financial support by covering medical expenses such as hospitalization, doctor visits, prescription drugs, and preventive care. Having health insurance ensures that you can access necessary healthcare services without facing significant financial burdens. Additionally, many countries mandate health insurance to ensure that their citizens receive essential medical care.

Description: Auto insurance is a legal requirement in most countries for anyone owning a vehicle. It offers financial protection in case of accidents, theft, or damage caused by your vehicle to others or their property. Different types of auto insurance, such as liability, collision, and comprehensive coverage, cater to various needs. It is crucial to have appropriate auto insurance to avoid potential financial losses and legal issues in the event of an accident.

Description: Life insurance is a policy that provides a lump sum payment to beneficiaries upon the insured’s death. It is an essential financial planning tool that offers peace of mind, knowing that your loved ones will have financial security and stability after you are gone. Life insurance can be used to cover funeral expenses, outstanding debts, mortgage payments, and even provide income replacement for the family. The amount of coverage needed depends on individual circumstances, such as family size, outstanding debts, and future financial goals.

Description: Homeowners insurance is designed to protect your home and personal belongings against unexpected events like fire, theft, vandalism, or natural disasters. It provides coverage for both the physical structure of your home and your possessions inside it. Moreover, homeowners insurance often includes liability coverage, which protects you if someone is injured on your property. Lenders typically require homeowners insurance for anyone with a mortgage to safeguard their investment.

Description: Travel insurance offers coverage for unforeseen events that may occur during your travels, both domestically and internationally. It can include benefits such as trip cancellation/interruption, medical emergencies, lost luggage, travel delays, and emergency evacuation. Travel insurance is especially important when planning expensive trips, traveling to remote locations, or engaging in adventurous activities. It helps mitigate financial losses and provides assistance when facing unexpected challenges away from home.

Newsletter Sign-Up:

Stay in the Loop!

Receive important insurance information right in your inbox weekly!

Newsletter Form | Email Verication