Does Medicare Cover Phenobarbital?

When you're living with epilepsy or certain mental health conditions, phenobarbital is a medication that may help you control the symptoms. This prescription drug is widely available at pharmacies; if you take it on a regular basis, it's helpful to understand the potential out-of-pocket costs.

While Original Medicare doesn't typically cover phenobarbital, Part D prescription drug plans can help keep costs in check — 100% of Part D plans cover the medication. Certain Medicare Advantage plans may also cover the costs of phenobarbital. If you're in the process of choosing drug coverage, it's a good idea to check the formulary to find the tier and co-pay for phenobarbital and any other prescriptions you take. 

What Is Phenobarbital?

Phenobarbital is a barbiturate that's typically used to treat seizures, either on its own or in combination with other seizure medications. It's a sedative, so your doctor may also prescribe it to help reduce the effects of anxiety. In some cases, doctors prescribe phenobarbital to manage withdrawal symptoms from alcohol or another type of medication.

Phenobarbital is available in tablet and liquid form. Phenobarbital brand names include Luminal and Solfoton, but you can also find generic options.

Phenobarbital Side Effects

When you start taking phenobarbital, your doctor may adjust the dosage slowly. Phenobarbital side effects include headaches, nausea and vomiting; because the drug is a sedative, you may also feel drowsy or dizzy. For that reason, it's important to avoid driving and drinking alcohol.

Some people may experience more severe side effects that require immediate medical attention, such as decreased breathing, swelling of the face, fever and rashes. Consult your doctor before stopping the prescription; if you stop immediately rather than gradually, you may experience significant withdrawal symptoms.

How Much Does Phenobarbital Cost With Medicare?

The actual price of phenobarbital can vary significantly based on your location, your drug plan and the pharmacy you choose. When you have a Medicare Advantage plan or Medicare Part D prescription drug coverage, the amount you pay depends on whether you've met your annual deductible.

Check your plan details to find the deductible; for Part D plans, it can't be higher than $545 in 2024 and $505 in 2023. If your drug costs haven't reached that amount, you may be responsible for the full cost. Phenobarbital tends to be a relatively affordable medication, and you can save money by requesting a generic version.

If you've met your deductible, the only cost for your phenobarbital prescription will be the co-pay. This amount varies depending on your plan — insurers categorize drugs into tiers, and lower tiers have lower co-pays. The co-pay may be different depending on whether you choose a generic or brand-name version. Some plans cover certain drugs before you meet the deductible.

Every Medicare-approved Part D plan is required to cover phenobarbital. This has been the case since 2013, when the U.S. Department of Health & Human Services mandated coverage for barbiturates and benzodiazepines.

Does Medicare Place Restrictions on Phenobarbital Coverage?

The U.S. Drug Enforcement Administration classifies phenobarbital as a Schedule IV controlled substance because it may be habit-forming. As a result, there's a chance that your Medicare Part D plan may restrict coverage. This might include setting a maximum amount per month or limiting coverage to conditions such as epilepsy or a chronic mental health condition.