Does Medicare Cover Demadex?

If you're one of the 45% of Americans with hypertension (high blood pressure), you may need to take medication to treat your symptoms or prevent adverse health events. However, the costs of treating high blood pressure can soon add up. This article explains whether Medicare covers Demadex, a drug commonly prescribed to people with hypertension.

What Is Demadex?

Demadex is the brand name of a medication containing torsemide. Torsemide is a type of diuretic used to treat edema (fluid retention) caused by high blood pressure. Your doctor may recommend using torsemide if you have a medical condition that causes edema, such as heart or lung disease. 

Most people take a single daily Demadex tablet to control their symptoms, but your doctor may prescribe a different dose depending on your condition. Sometimes, health care providers recommend reducing the amount of salt or increasing the amount of potassium in your diet while taking Demadex. 

Demadex Side Effects

Like most prescription drugs, Demadex can cause side effects. These may include:

• Increased urination
• Cough
• Constipation or diarrhea
• Tinnitus or hearing loss
• Headache
• Sore throat
• Stomach problems

Does Medicare Cover Demadex?

You're reasonably likely to have coverage for generic torsemide if your Medicare plan includes prescription drug coverage. Around 96% of Medicare prescription drug plans cover torsemide, although it's unclear how many cover the Demadex brand. 

Medicare is unlikely to cover generic torsemide or Demadex if you only have Parts A and B (Original Medicare.) Original Medicare occasionally pays for doctor-administered drugs in a clinical setting. Still, this exception is unlikely to apply to oral medications, such as Demadex, if you take them at home. 

If you have Medicare Part D or a Medicare Advantage plan that includes medication coverage, you can determine which torsemide medications your policy covers by checking the formulary. Generic torsemide and Demadex are affordable drugs, so they usually fall within the lowest formulary tier (Tier 1).

How Much Does Demadex Cost With Medicare Coverage?

Most pharmacies charge around $55 or less for 30 20-milligram Demadex tablets without prescription drug coverage. Therefore, you should expect to pay roughly this amount for your prescriptions until you satisfy your annual deductible. Your plan's deductible is the amount you must spend out of pocket before your insurance begins paying for your medication. 

Annual deductibles depend on the type of Medicare coverage. Medicare Part D deductibles are capped at $545 in 2024 and $505 in 2023, although your insurer can set deductibles lower than the mandatory limit. Medicare Advantage deductibles are less regulated, with some insurers waiving deductibles altogether and others charging several thousand dollars. 

You may have to contribute a co-pay toward the cost of your prescriptions after paying the deductible. Some Medicare Advantage and Part D plans don't charge co-pays for affordable medications such as Demadex. Others impose a nominal copay of $1 or less for drugs containing torsemide.

Does Medicare Restrict Coverage for Demadex?

Medicare coverage restrictions for Demadex are relatively rare. Therefore, most insurers don't require authorization from your doctor before approving your claim or limit how many Demadex tablets your pharmacist can dispense.