Does Medicare cover cilostazol?
Cilostazol is a generic prescription medication (brand examples include Pletal) used for conditions such as intermittent claudication (pain from poor blood flow). Whether Medicare covers it depends on which part of Medicare you have and how the drug is listed on your plan’s formulary.
If you have Original Medicare (Part A and Part B), prescription drugs are generally not covered under Parts A or B. Coverage for cilostazol usually requires a Medicare Part D plan (or a Medicare Advantage plan that includes Part D) that covers outpatient medications through a formulary [1].
Original Medicare vs. Part D: where coverage usually happens
Under Original Medicare, Part B generally covers certain medical services and limited drug categories, not routine oral prescription drugs like cilostazol. To get coverage for cilostazol, most people need Part D drug coverage (standalone Part D or Medicare Advantage with prescription drug coverage) [1].
What to check in your plan before relying on coverage
Even with Part D, coverage depends on your specific plan’s rules:
- Whether cilostazol is on the plan’s formulary.
- What tier it’s on (which affects your copay/coinsurance).
- Whether you must meet prior authorization, step therapy, or other coverage requirements. These can change how easily you can get the drug approved [1].
How much you might pay
Your out-of-pocket cost for cilostazol varies by plan and tier and can also depend on whether you fall into a particular stage of the Part D benefit (for example, deductible/coverage phases). The only reliable number is what your plan shows for cilostazol in its formulary/cost lookup tool [1].
If your plan doesn’t cover cilostazol
If cilostazol isn’t covered on your plan’s formulary or is restricted, you can typically ask the plan for an exception or coverage determination. Plans may require documentation from your clinician depending on the reason for the request [1].
Sources
[1] https://www.medicare.gov/drug-coverage