Does Medicare Cover Malathion?

Realizing you have head lice is enough to make anyone's heart sink, and having to spend money on head lice treatments just adds insult to injury. However, many people are surprised to learn that their healthcare insurance may cover some of the costs of treatments, such as malathion. So, does Medicare cover malathion, and how much will you pay out of pocket?

What Is Malathion?

Malathion is a synthetic organophosphate used to treat head lice in adults and children. It can kill adult lice and their eggs and comes as a solution or lotion that you apply to your hair and scalp. Malathion is mainly recommended for people aged 6 and over and is unsuitable for children under 2.

Doctors usually recommend leaving malathion lotion on your head for 8 to 12 hours before washing it out with warm water. You should avoid getting the solution in your eyes and wash your hands thoroughly after touching the medication. Use a head lice comb after rinsing to remove any dead insects and eggs from your hair. 

Occasionally, malathion can make your scalp sore and irritated. It's best to seek prompt medical attention if your symptoms are severe. 

A single malathion treatment is often enough to eradicate head lice. However, you may need to repeat the treatment roughly a week later if you notice live insects on your hair or scalp.

Does Medicare Cover Malathion?

Medicare Parts A and B cover prescription medications in limited circumstances when administered directly by a healthcare professional. Therefore, Original Medicare doesn't cover malathion. However, you may have malathion coverage if you purchase a separate Medicare Part D (prescription drug coverage) policy. 

Roughly 95% of Medicare Part D plans cover malathion. You can determine whether your insurer covers malathion by looking at the formulary, which lists the medications covered. Most insurance companies categorize malathion under Tier 4, but this can vary by provider. 

If your plan doesn't cover malathion, it's worth asking your doctor if they can recommend suitable alternatives. Your plan may include other organophosphate medications to treat your condition.

How Much Does Malathion Cost With Medicare?

Assuming your Part D plan covers malathion, your coverage won't kick in until you meet your annual deductible. Your deductible depends on your policy and provider, but the legal upper limit is $545 in 2024. While some companies offer significantly lower deductibles, they tend to charge higher monthly premiums. 

Therefore, you're usually responsible for paying for your malathion prescription out of pocket until you spend an amount equal to the deductible. Malathion is a surprisingly expensive medication, costing $249.09 on average for a 59-milliliter bottle. However, it's worth shopping around to see which pharmacy offers the lowest prices and checking for coupons to reduce the cost of your prescription. 

Once you've paid the deductible, your insurer covers most of the costs. However, you'll usually be liable to pay a small co-pay of between $1 and $4.

Does Malathion Restrict Coverage for Malathion?

Most Medicare Part D plans offer unrestricted malathion coverage. However, some insurers may ask for prior authorization from your doctor to ensure your treatment is medically necessary or restrict the amount your pharmacy can dispense in a single visit.