Does Medicare usually cover Nuedexta (dextromethorphan/quinidine)?
Medicare coverage for Nuedexta depends on whether it is billed as a covered drug under your plan. Nuedexta is a prescription medication, so it’s typically covered under a Medicare Part D prescription drug plan (or a Medicare Advantage plan that includes Part D). Coverage rules vary by plan’s formulary, tier, and prior authorization requirements [1].
What Medicare part applies—Part D or Medicare Advantage?
- If you have Original Medicare (Part A and Part B), drug coverage generally comes through Part D, not Parts A/B [1].
- If you have a Medicare Advantage plan, prescription coverage may be included through the plan’s Part D portion (rules still follow formulary coverage) [1].
How can you tell if your plan covers Nuedexta?
Check your plan’s formulary (the list of covered drugs) for “Nuedexta” or its active ingredients (dextromethorphan/quinidine) and look for:
- Your cost-sharing tier (copay/coinsurance)
- Any prior authorization requirement
- Whether step therapy applies (trying other drugs first) [1]
What might you pay if it’s covered?
Even when a drug is on the formulary, your price can vary widely by plan and by whether you’ve met deductibles or coverage thresholds. Your plan documents or the plan’s member portal will show your specific cost for Nuedexta [1].
What if your plan does not cover Nuedexta?
If Nuedexta is not on your formulary (or is restricted), your plan may still be able to approve it through:
- A prior authorization request
- An exception request (for formulary non-coverage or higher cost tier) [1]
What information should you have ready to confirm coverage?
To get an accurate answer from your plan, have your:
- ZIP code
- Prescriber information (optional for the initial check)
- Plan name (and whether it’s Original Medicare with Part D or a Medicare Advantage plan)
- Your drug strength and quantity (Nuedexta comes in specific strengths), since coverage can vary by specific product
Sources
[1] https://www.medicare.gov/drug-coverage-part-d