Does Medicare Cover Oxtellar?

Oxtellar is a costly drug, so it's essential to plan how to cover the cost of your prescriptions. First, you should check whether your health insurance will pay for the medication you need. So, does Medicare Part D cover Oxtellar?

What Is Oxtellar?

Oxtellar XR (oxcarbazepine) is a branded medication used to manage partial-onset seizures in people with epilepsy. This medication is only suitable for adults and children aged 6 and older. 

Most adults take a single daily dose of 600 milligrams when they first start taking Oxtellar XR. Doctors usually increase the prescribed amount over time until the person achieves satisfactory symptom relief, provided they tolerate the medication well. Meanwhile, doctors usually calculate dosages for children based on body weight.

Oxtellar Side Effects

Reported side effects of Oxtellar include:

• Dizziness
• Drowsiness
• Headaches
• Tremors
• Double vision
• Lack of energy or weakness
• Vomiting

Does Medicare Cover Oxtellar?

Most Medicare Part D Plans (prescription drug plans) exclude Oxtellar, but coverage varies among insurance companies. You can determine whether your plan covers your medication by consulting the formulary, which provides a comprehensive list of covered drugs. 

Unfortunately, there isn't a generic alternative to Oxtellar. However, your plan will cover other anticonvulsant drugs used to manage epileptic seizures because they're a protected drug class. If your plan doesn't cover Oxtellar, you could consider asking your doctor whether a covered medication could appropriately treat your condition. 

How Much Does Oxtellar Cost With Medicare?

Assuming your Medicare Part D plan excludes Oxtellar, you'll need to pay for your prescription out of pocket. Prices for Oxtellar vary by area, although many pharmacies charge $1,377 or more for 60 600-milligram tablets. You may be able to save money by using discount coupons. 

If your plan covers Oxtellar, you must meet your deductible before claiming the cost of your medication through your insurance. Some providers don't charge deductibles — those that do can't legally set deductibles higher than $545 per year. After that, you'll pay a co-pay between $21 and $1,410 when you receive coverage, and your insurer will cover the remaining costs. 

Are There Medicare Coverage Restrictions for Oxtellar?

Coverage restrictions for Medicare Part D plans that include Oxtellar depend on each policy's terms. You may need to obtain prior authorization from your doctor, which means they must contact the company to certify that your prescription is medically necessary. Insurers may also limit how much medication your pharmacy can dispense per visit.