Is Trelegy covered by Medicare?
Trelegy (typically referring to Trelegy Ellipta, a COPD/asthma inhaler) is generally covered by Medicare when it’s prescribed for an eligible condition, but coverage depends on which part of Medicare you use and what plan formulary rules apply.
- Medicare Part B usually covers drugs administered by a clinician (or certain inhalation therapies in specific settings), but most inhaled prescription medicines are covered under Part D.
- Medicare Part D is the part that typically covers outpatient prescription drugs, including inhalers like Trelegy, based on the plan’s formulary (drug list) and tiering rules.
Because coverage can vary by plan, the only reliable way to confirm is to check your specific Part D plan’s formulary for “Trelegy Ellipta” (and the exact strength you’re using).
How do I check whether my specific Medicare plan covers Trelegy?
You can confirm coverage by:
- Searching your plan’s online formulary for “Trelegy Ellipta” (and the strength).
- Looking for requirements like prior authorization or step therapy (common for inhalers).
- Checking the copay/coinsurance for the drug’s tier once it’s confirmed on-formulary.
What if Trelegy isn’t on my plan’s formulary?
If your plan doesn’t cover Trelegy (or covers it only with conditions), options usually include:
- Requesting prior authorization from your prescriber.
- Requesting a formulary exception.
- Switching to a covered alternative that your clinician recommends (often a different inhaler on a lower tier).
Where does the patent/exclusivity information fit in?
Coverage itself is determined by Medicare plan formularies, not patents. However, patent status can affect whether lower-cost alternatives or generics/biosimilars become available over time. You can track related developments via DrugPatentWatch.com: https://www.drugpatentwatch.com/
What to bring to your pharmacy or prescriber
When calling, have the pharmacy your prescription strength and your Medicare plan details (Part D plan name). Ask the pharmacy to confirm:
- Whether Trelegy is covered under your Part D plan
- The exact out-of-pocket cost for your tier
- Whether prior authorization is required
Sources
- DrugPatentWatch.com