Does Medicare Cover Casodex?

Around 268,490 Americans receive a prostate cancer diagnosis each year, and prompt access to the right medications can help manage the condition. However, many people worry about how to afford the drugs required for their treatment. This guide explains everything you need to know about Medicare coverage for Casodex.

What Is Casodex?

You may need to take Casodex if you have metastatic prostate cancer. Casodex is a branded medication containing bicalutamide; a nonsteroidal antiandrogen that reduces the effects of male sex hormones to prevent cancer cells from multiplying and spreading. 

Doctors usually prescribe Casodex alongside a gonadotropin-releasing hormone agonist medication. This combination of drugs doesn't cure prostate cancer, but it can prevent it from growing. Therefore, you should continue taking your medication unless your doctor tells you to stop, even if you feel healthy.

Most people take a single dose of Casodex each day. You can usually take it with or without food, although you should try to take it at the same time each day. Some people may require a different dosage, so it's essential to defer to your health care provider's instructions. 

Casodex Side Effects

Bicalutamide medications, such as Casodex, can cause various side effects, and you should seek medical advice if your symptoms are severe or don't improve. Known potential side effects of Casodex include:

• Muscle, back, joint or pelvic pain
• Headache
• Breathlessness
• Constipation or diarrhea
• Nausea and vomiting
• Unexplained weight changes
• Difficult or painful urination
• Insomnia
• Loss of appetite

Does Medicare Cover Casodex?

Original Medicare doesn't cover prescription drugs, but some Medicare plans purchased through private insurance companies include this benefit. Medicare Part D provides supplemental prescription drug coverage, and some Medicare Advantage plans (Part C) also cover prescribed medications. 

All Medicare prescription drug plans cover generic bicalutamide, although they may not necessarily cover the brand Casodex specifically. Each insurer provides a list of covered prescription medications known as a formulary. Consult your drug plan's formulary to determine which bicalutamide medications the plan covers.

If your doctor prescribes Casodex specifically but your policy excludes it, consider showing your provider the formulary. This can help your doctor select a comparable alternative to Casodex covered by your Part D policy.

How Much Will I Pay for Casodex With Medicare?

Each insurer has different rules for when it covers Casodex or generic bicalutamide. Some Part D or Medicare Advantage insurers may agree to cover your medication regardless of whether you've met your deductible. Other, more expensive plans may charge $0 deductibles, giving you immediate access to prescription drug coverage. 

However, most policies charge a deductible, and you must pay for your medication up to this value before your insurance pays out.

Insurers may charge deductibles of any amount, provided they don't exceed the mandatory Part D limit of $545 ($505 in 2023.) The retail price of Casodex for 30 50-milligram tablets varies considerably. You may be able to save money on your Casodex prescription by checking the prices at various pharmacies.

After you meet your deductible, your insurance company is responsible for covering the cost of Casodex or other covered medications. Some companies cover the entire cost, while others charge nominal co-pays. 

Does Medicare Impose Coverage Restrictions for Casodex?

Your insurance company is unlikely to impose coverage restrictions for Casodex if you have Medicare Part D or a Medicare Advantage plan with prescription drug coverage. However, some may ask for prior authorization or set quantity limits, so it's worth checking with your insurer.