Does Medicare Cover Savella?

If you live with fibromyalgia, the right medications can help you manage symptoms; Savella is one potential option. If you have a Medicare Part D plan, there's a chance it might help you pay for the prescription; 63% of Medicare drug plans cover Savella. Some Medicare Advantage plans also include prescription drug benefits.

What Is Savella?

Savella is one of the prescription drugs doctors use to alleviate the symptoms of fibromyalgia. It's a branded version of milnacipran HCl, a selective serotonin and norepinephrine reuptake inhibitor. Savella comes in tablet form and is only used for adults.

Fibromyalgia is a chronic condition that makes you feel pain all over your body. Savella prompts your body to create more serotonin and norepinephrine, which can help block the pain signals in your brain. As a result, you may feel less discomfort.

While Savella can help you manage fibromyalgia, it doesn't cure the condition. Given the potential side effects, doctors typically start with a smaller dose and increase it as necessary. To prevent potential drug interactions, it's important to communicate all other medications clearly. This is particularly important if you're taking MAO inhibitors, which should not usually be taken with Savella.

What's the Price of Savella With Medicare?

Savella can be an expensive medication; a single pack may cost $500 or more. If your Medicare prescription drug plan covers Savella, your costs will depend on where you fill the prescription and which coverage phase you're in. Until you hit your plan's deductible, the pharmacy will charge you the full price of the drug. Some plans have low deductibles; others have the Medicare maximum of $545 per year for 2024 ($505 in 2023).

With Savella, you're likely to meet your deductible quickly. Then, you only need to worry about the coinsurance or co-pay. Savella is usually a Tier 3 medication; your plan's formulary can tell you the tier and the co-pay amount.

After you reach $5,030 in drug costs for 2024 ($4,660 in 2023), you enter the coverage gap. At this point, you'll pay up to 25% of the price. This continues until your out-of-pocket costs hit $8,000 in 2024 (or $7,400 in 2023). Then, you're back to paying the coinsurance or co-pay until the end of the year.

Medicare Prescription Restrictions for Savella

Many Medicare prescription drug plans have coverage restrictions, which might include limits on the quantity. In some cases, your doctor may need to verify that Savella is medically necessary before your plan will provide coverage.