Does medicare cover viberzi?

Does Medicare cover Viberzi (eluxadoline)?

Viberzi is a prescription medicine. Whether Medicare pays for it depends on what type of coverage you have (Part D vs. Part A/B) and whether Viberzi is on your specific plan’s formulary. Medicare Part A and Part B generally do not cover outpatient prescription drugs; those are usually covered under Medicare Part D (or a Medicare Advantage plan that includes Part D drug coverage).

If your question is simply “does Medicare cover it,” the practical answer is: it may be covered under Part D if your plan covers Viberzi on its formulary.

What Medicare part would cover it?

• Medicare Part D (standalone prescription drug plans) typically covers outpatient prescription drugs like Viberzi.
  
• Medicare Advantage plans often include drug coverage (Part D). If your plan includes prescription coverage, it may cover Viberzi under its formulary rules.
  
  

How to check if your plan covers Viberzi

To confirm coverage for your exact situation, check one of these:
- Your plan’s drug formulary (search “Viberzi” or “eluxadoline”).
- The plan’s “tier” and cost-sharing details (what you pay may vary by tier).
- Any required step therapy or prior authorization (some plans require these for certain drugs).

What if it’s not covered?

If your plan doesn’t cover Viberzi or covers it only with restrictions, you can typically request:
- Prior authorization (if the plan has criteria you can meet)
- A formulary exception (asking the plan to cover it anyway)
- An alternative covered medication (your prescriber can help determine options)

If you tell me your state and whether you have Original Medicare with Part D or a Medicare Advantage plan (and the plan name, if you know it), I can help you figure out the most likely way to check coverage for your specific plan.

Sources

No sources were provided with the question.