Does Medicare Cover Brilinta?

Taking Brilinta can help reduce your chances of experiencing a serious health event, making it a useful tool in preventative healthcare. It's a mid-price drug, and taking it can become expensive, as most people use it for years at a time. Fortunately, a Medicare Part D plan may help reduce your out-of-pocket costs. 

What Is Brilinta?

Brilinta (ticagrelor) is an antiplatelet medication used to reduce the risk of strokes, heart attacks and cardiovascular death. There is no generic alternative. Your doctor may prescribe Brilinta if you have a higher risk of experiencing these events. For example, this medication is commonly prescribed to people with a history of heart attacks or a diagnosis of coronary artery disease.

This medication comes as a 60-milligram or 90-milligram tablet, and your doctor will determine the correct dosage based on your age, health status and condition. Some people require a large starting dose of Brilinta known as a "loading dose," followed by a maintenance dose of one tablet twice per day. Your doctor may also recommend taking a maintenance dose of aspirin alongside Brilinta.

Like all medications, Brilinta can cause unwanted side effects. The most common Brilinta side effects are bleeding and shortness of breath.

Does Medicare Cover Brilinta?

Original Medicare (Parts A and B) rarely covers prescription drugs. However, you can purchase supplemental Medicare Part D plans (prescription drug coverage) from approved private providers.

Brilinta is covered by 100% of Medicare Part D policies. Most insurers class this medication under Tier 3 of their formularies, which is the list of covered medications. 

Brilinta Cost With Medicare Part D Coverage

Your out-of-pocket costs for Brilinta depend on your Medicare Part D deductible. You must meet your deductible before receiving coverage for prescription drugs, and deductibles cannot exceed $545. However, many insurers cover certain drugs during the deductible stage, which may include Brilinta.

If not, you're responsible for meeting the costs of your prescription until your spend equals or exceeds your annual deductible. Prices for Brilinta vary from pharmacy to pharmacy, but most charge north of $500 for Brilinta 90 mg tablets. 

Once you've met your deductible, your insurance company will pay for your Brilinta prescription. Co-pays for Brilinta are typically modest, costing enrollees between $1 and $8 per prescription on average.

Are There Any Medicare Coverage Restrictions for Brilinta?

Most Medicare Part D insurers provide unrestricted coverage for Brilinta. Therefore, your medication is unlikely to be subject to prior authorization requirements or quantity limits.