Does Medicare Cover Nolvadex?

Having prescription drug coverage can be reassuring when you receive a breast cancer diagnosis because the medications used to treat cancer are often expensive. This guide answers frequently asked questions about Medicare coverage for Nolvadex. 

What Is Nolvadex and What Does It Treat?

Nolvadex is a branded selective estrogen receptor modulator containing the generic drug tamoxifen. Some health care providers also prescribe Soltamox, which is another branded medication containing tamoxifen. Nolvadex comes as a tablet, while Soltamox comes as a liquid suspension. 

Doctors use Nolvadex and similar medications to prevent and treat hormone receptor-positive breast cancer. It works by binding to hormone receptors in cancer cells to stop them from growing and spreading. Your health care provider may recommend Nolvadex if you currently have breast cancer or have a higher risk of developing it in the future.

Most people take Nolvadex once a day for 5-10 years. Sometimes, doctors recommend using Nolvadex for the first 5 years before changing to a different medication. The precise dosage requirements depend on your diagnosis and overall health status. 

Nolvadex Side Effects

Nolvadex and other types of tamoxifen may cause the following side effects:

• Hot flashes and sweating
• Vaginal dryness
• Menstrual changes
• Swollen legs
• Rash
• Tiredness 
• Headaches
• Weight gain

Will My Medicare Plan Cover Nolvadex?

Medicare coverage for Nolvadex depends on whether your plan includes prescription drug coverage. You won't usually qualify for Nolvadex coverage if you only have Medicare Parts A and B because they don't include prescription drugs as a covered benefit.

However, 100% of Medicare Part D plans (prescription drug coverage) cover medications containing tamoxifen, which may include Nolvadex or similar branded drugs. You can find out which version your plan includes by consulting the formulary. These drugs typically appear under Tier 2. If your insurer doesn't cover the brand prescribed by your health care provider, your doctor may suggest a different version. 

You may also be eligible for Nolvadex coverage if you purchase a Medicare Advantage plan through an approved private insurance company. These plans must offer at least the same benefits as Medicare Parts A and B. However, many policies include extra benefits, such as prescription drug coverage. The drugs your plan covers depends on your insurer.

How Much Will I Pay for Nolvadex With Medicare Coverage?

Nolvadex prices depend on where you live and which pharmacy you use, but most charge a retail price of around $80 or less for 30 20-milligram tablets. If you have a Medicare Part D plan, you'll pay the pharmacy's retail price for your medication until you spend enough to cover your annual deductible. 

Deductibles vary by plan type, but they can't exceed $545 ($505 in 2023) if you have Medicare Part D. However, many insurance companies set lower Part D deductibles than the legal maximum. Medicare Advantage plan deductibles are less restricted, with some insurers waiving deductibles altogether and others charging several thousand dollars. You can determine your Medicare Advantage deductible by checking your policy paperwork. 

Once your insurance coverage kicks in, your insurer may pay most of your medication costs. Part D co-pays for Nolvadex rarely exceed $2, and many insurers don't charge co-pays for this medication.

Does Medicare Restrict Nolvadex Coverage?

Most Medicare Part D insurers offer unrestricted Nolvadex coverage. Therefore, you don't usually need authorization from your health care provider. Your insurance company is unlikely to restrict how much medication your pharmacist can dispense.