Does medicare cover anafranil?

Short answer:
Medicare usually covers clomipramine (brand name Anafranil) through Part D (the prescription‑drug benefit). Whether you actually pay anything depends on the specific Part D plan you’re enrolled in and whether the drug is on that plan’s formulary (or if the generic version is listed).

How Medicare typically handles Anafranil

Things to check

1. Plan formulary – Use the Medicare Plan Finder or the “Drug Coverage” section of your plan’s website to see if clomipramine is listed.
2. Generic vs. brand – The generic form (clomipramine hydrochloride) is usually cheaper and more likely to be on formulary.
3. Tier placement – Drugs are divided into tiers (e.g., Tier 1 = preferred, Tier 2 = nonpreferred, etc.). A higher tier usually means a higher copay.
4. Specialty coverage – If the drug isn’t on the formulary, you can file a specialty drug appeal with your plan.
5. Prescription drug discount cards – If the cost is still high, you might qualify for a discount card (e.g., CVS ExtraCare, Walmart Pharmacy) that can reduce the copay.

Practical next steps

1. Log into your Medicare portal or call your Part D plan’s customer service line.
2. Ask:
   • “Is clomipramine (Anafranil) on my formulary?”
   • “What tier is it, and what will my copay/coinsurance be?”
   • “If it’s not on the formulary, can I request specialty coverage?”
3. If you’re on a Medicare Advantage plan, check the plan’s prescription‑drug summary.
4. Keep a copy of the prescription and the plan’s drug coverage page; you’ll need it when you fill the medication or when you file an appeal.

Bottom line

• Covered: Yes, via Medicare Part D (or the Part D component of an MA plan).
• Not covered by Part B (since it’s an oral medication).
• Coverage details (copay, tier, out‑of‑pocket costs) depend on your specific plan.

If you run into any problems or need help navigating the formulary, consider reaching out to a Medicare counselor or a pharmacist for personalized assistance.