Does Medicare Cover Effexor?

If you're experiencing anxiety or depression, it can be helpful to know whether your insurance will cover the cost of your treatment. Doctors may recommend medications, such as Effexor, alongside other therapies to relieve your symptoms. Below, you can find out if your Medicare Part D policy covers Effexor and Effexor XR.

What Is Effexor?

Effexor and Effexor XR are branded versions of venlafaxine. Venlafaxine is an antidepressant used to treat major depressive disorder (MDD), anxiety and panic disorder. The medication comes in immediate-release (IR) and extended-release (XR) forms. 

Most people who take Effexor usually take two or three doses each day. Typically, doctors prescribe a low dose of around 37.5 milligrams and gradually increase the amount until the person experiences satisfactory symptom relief. The correct dosage can vary from person to person, so it's essential to follow your doctor's instructions.

You should avoid drinking alcohol while taking Effexor because it can increase the medication's sedating effects and make it less effective at treating your symptoms. You may begin to see improvements after a week or two of starting Effexor, but it could take up to 8 weeks before your symptoms improve significantly.

Your symptoms could return if you stop taking Effexor suddenly, even if you feel well. Therefore, it's best to consult your doctor if you no longer wish to take your medication or believe you no longer need it. They may recommend tapering your dose to avoid unwanted effects from withdrawal. 

Effexor Side Effects

It's generally safe to take Effexor and Effexor XR over extended periods. However, it can sometimes cause side effects, including:

• Headache
• Diarrhea
• Excessive sleepiness
• Insomnia
• Restlessness
• Nausea
• Mouth dryness
• Sweating

Does Medicare Cover Effexor?

You're unlikely to qualify for Effexor coverage if you only have Original Medicare because it rarely covers outpatient prescription medications. 

All Medicare Part D policies cover Effexor, Effexor XR or generic equivalents. These medications generally come under Tier 2 of the list of covered drugs, known as the formulary. If you can't find Effexor, consider asking your doctor to prescribe generic venlafaxine or venlafaxine XR.

How Much Does Effexor Cost With Medicare?

Enrollees must usually pay for their medication until they meet their Medicare Part D deductible, unless they have a deductible-free plan or their insurer covers the drug during the deductible stage. Therefore, you'll pay for Effexor out of pocket, up to the maximum legal deductible of $545 before your insurance kicks in.

Fortunately, Effexor and Effexor RX are both relatively inexpensive. Effexor typically costs around $47.12 for 30 75-milligram tablets. Meanwhile, Effexor RX costs somewhat more, at roughly $82.34 for 30 150-milligram capsules. Checking at several pharmacies can help you find the lowest prices, and it's also worth looking for coupons to reduce the cost of your medication. 

Once you meet your premium, you'll only have to pay a small co-pay when you receive coverage for Effexor or Effexor RX. Some companies waive co-pays for this medication, while others make a nominal charge of around $1 or less.

Do Restrictions Apply to Effexor Coverage With Medicare?

Your insurer may set quantity limits for your medication, especially if you take Effexor RX. Quantity limits prevent you from receiving large amounts of medication at a time.