Will Medicare pay for Chantix?
In most cases Medicare doesn't cover Chantix under its Part D coverage, leaving customers with the nearly $400 bill. However, that doesn't mean you can't get it covered, as Medicare does cover Chantix under Part C Medicare Advantage plans. If you can find a Part C plan with Medicare that does cover Chantix, you could end up paying as little as $10 per supply.
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Justin Wright
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Justin Wright has been a licensed insurance broker for over 9 years. After graduating from Southeastern Seminary with a Masters in Philosophy, Justin started his career as a professor, teaching Philosophy and Ethics. Later, Justin obtained both his Property & Casualty license and his Life and Health license and began working for State Farm and Allstate. In 2020, Justin began working as an i...
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UPDATED: Nov 8, 2023
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Editorial Guidelines: We are a free online resource for anyone interested in learning more about auto insurance. Our goal is to be an objective, third-party resource for everything auto insurance related. We update our site regularly, and all content is reviewed by auto insurance experts.
UPDATED: Nov 8, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance providers please enter your ZIP code above to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
- Traditional Medicare doesn’t cover Chantix under Part D drug coverage
- You may be able to get it through a Medicare Advantage plan
- Medicare does offer up to eight counseling sessions per year to help you stop smoking
Does Medicare cover Chantix? While traditional Medicare might not cover the smoker-quitting drug, that doesn’t mean you don’t have options. Some compatible Medicare Part C plans will be able to offer you coverage on Chantix. In addition, Medicare health insurance does cover up to eight counseling sessions per year to help you stop smoking.
Now that you know Medicare doesn’t cover Chantix enter your ZIP code into our free quote tool to see what you could pay for a policy that does.
When does Medicare pay for Chantix?
Medicare is a service that helps those over 65 save on medical and prescription costs. But, do those savings extend to the tobacco quitting drug Chantix? While this drug has been shown to help people experiencing withdrawal symptoms for smoking, whether it’s covered or not will likely depend on your insurance.
Like most health insurance programs, Medicare puts a lot of weight on preventing more severe illnesses. Since cigarettes are linked to diseases like cancer, Medicare offers services to help its customers save. Medicare Advantage plans may cover a variety of prescription smoking-ceasing drugs like:
- varenicline – Chantix
- bupropion – Zyban
- nicotine replacement therapy – nasal spray or inhaler
With these tools, you should have a much easier time dealing with the side effects when you stop smoking tobacco. In addition to these drugs, Medicare also offers up to eight counseling sessions per year to help you deal with the urge to stop smoking.
Which Medicare Parts could cover Chantix?
Medicare insurance is currently split into four parts that cover different charges in medicine. These designations make it easier to file claims and understand what’s covered where. These four Parts of Medicare include:
- Part A – covers inpatient hospital stays and associated costs while you’re there
- Part B – Outpatient services that are deemed medically necessary or preventative
- Part C – Medicare Advantage allows the program to partner with private insurance companies to offer extended coverage
- Part D – Part D covers prescription drug costs and vaccines
While you might imagine Medicare would cover Chantix under Part D, you’ll need a Medicare Advantage plan. Traditional Medicare doesn’t cover drugs like Chantix, so you’ll need to go through a compatible Part C provider that covers those drugs that help you quit smoking.
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How much does Chantix cost without insurance?
How much is Chantix? The reason that you’re likely looking for help paying for Chantix is due to the high cost associated with the medicine. Using GoodRx, some of the prices across retailers for the drug include:
- Kroger Pharmacy – $350.79
- Walgreens – $205.55
- CVS Pharmacy – $376.55
- Walmart – $389.35
- Publix – $377.45
As you can see, this drug is nearly $400 at most retail companies for 60 1mg tablets. So it’s wise to find an insurance company to help you cover those costs. Otherwise, you’ll be paying hundreds of dollars each time you need a resupply.
While Medicare might not traditionally cover this medicine, you can get a Medicare Advantage plan that can help. How much it covers will likely depend on your plan, but at least you won’t pay $400 for a single supply of Chantix.
What is the Chantix cost with insurance?
According to Healthline, Chantix with the right insurance plan can cost as low as $10 per supply, depending on your prescription drug plan. This is a considerable difference in price if you can find an insurance company willing to offer the prescription at that price.
Health insurance companies will always prefer that you prevent an illness before you have to treat it, including the diseases associated with smoking. Therefore, some insurance companies likely view Chantix and other similar drugs as preventative measures in the long run.
What is Chantix used for?
Chantix is a medicine known to reduce the side effects for people who’ve stopped smoking cigarettes. However, since the process can be difficult, anything that offsets cravings and other symptoms is welcomed. While taking Chantix, it’s recommended that you also attend support and education groups to better your chance of success.
The successful cessation of smoking will lower lung and heart disease, prolonging your life and lowering what your insurance will pay later.
Does Medicare offer other options to quit smoking?
Medicare offers a variety of preventative services meant to help individuals before there is a severe illness or injury. In addition, Medicare offers various physical and mental health services intended to prevent the worst. Those services include up to eight counseling sessions per year to help you stop smoking.
During those counseling sessions, you’ll be educated on what your body is going through and how to prepare and deal with some of the symptoms. This can also help you understand your feelings and responsibly deal with your cravings.
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Case Studies: Medicare Coverage for Chantix
Case Study 1: John Doe
John Doe is a Medicare beneficiary who wants to quit smoking and has been prescribed Chantix by his healthcare provider. However, John is unsure whether Medicare will cover the cost of this medication. After consulting with his Medicare Part D plan, John discovers that Chantix is indeed covered under his plan’s formulary. As a result, he only has to pay a copayment for each prescription refill.
Case Study 2: Jane Smith
Jane Smith is also a Medicare beneficiary seeking assistance in quitting smoking. Like John, she has been prescribed Chantix by her doctor. However, Jane’s Medicare Advantage plan does not include Chantix on its formulary. In this case, Jane decides to explore alternative options and discusses potential alternatives with her healthcare provider, such as nicotine replacement therapy.
Although Chantix is not covered by her plan, Jane successfully finds a covered alternative that meets her needs.
Case Study 3: Robert Johnson
Robert Johnson is a Medicare beneficiary with a standalone Medicare Part D prescription drug plan. He wants to use Chantix to quit smoking, but upon reviewing his plan’s formulary, he discovers that Chantix is not included. Robert is determined to pursue this treatment and decides to file an exception request with his plan.
After providing supporting documentation from his healthcare provider, Robert’s exception request is approved, and his plan agrees to cover Chantix for him.
Case Study 4: Sarah Thompson
Sarah Thompson, a Medicare beneficiary, has Original Medicare (Parts A and B) but does not have a prescription drug plan. She also wants to quit smoking and has been prescribed Chantix. Since Original Medicare does not cover prescription medications like Chantix, Sarah decides to enroll in a standalone Medicare Part D plan.
After selecting an appropriate plan that includes Chantix on its formulary, Sarah is able to obtain coverage for the medication.
Medicare Paying for Chantix: The Bottom Line
Does Medicare cover Chantix? Like a lot of Medicare coverage, it depends. If you’re looking for traditional Medicare to cover the Chantix cost, you’ll be disappointed. However, Medicare Advantage plans will cover the Chantix price, some as low as $10 per supply. Medicare also offers counseling services to help you quit smoking.
Now that you know that Medicare doesn’t cover Chantix, you can enter your ZIP code into our free quote tool to see what you’d pay with a company that does.
Frequently Asked Questions
Are there any restrictions or limitations on Medicare coverage for Chantix?
Yes, there are certain restrictions and limitations to consider regarding Medicare coverage for Chantix. Here are some key points:
- Prescription Requirement: To be eligible for Medicare coverage of Chantix, it must be prescribed by a healthcare provider who is enrolled in Medicare and authorized to prescribe medications.
- Medical Necessity: Medicare typically requires that medications be deemed medically necessary for coverage. In the case of Chantix, it is generally covered when prescribed for smoking cessation purposes and when other criteria are met.
- Quantity Limits: Medicare Part D plans may impose quantity limits on Chantix. This means there may be a restriction on the number of Chantix doses or refills that can be obtained within a specific time frame.
- Step Therapy: Some Part D plans may require individuals to follow a step therapy process before covering Chantix. This means that the plan may require the use of certain other medications or treatments before approving coverage for Chantix.
- Coverage Determinations: If there are any concerns or issues with Medicare coverage for Chantix, beneficiaries have the right to request a coverage determination from their Part D plan. This involves contacting the plan to explain the situation and provide any necessary documentation or supporting information.
Will Medicare pay for Chantix?
Yes, Medicare may cover Chantix (varenicline) under certain circumstances. Chantix is a prescription medication used to help individuals quit smoking. Here are some important details regarding Medicare coverage for Chantix:
- Medicare Part D: Chantix is typically covered under Medicare Part D prescription drug plans. Part D plans are offered by private insurance companies approved by Medicare. These plans help beneficiaries pay for prescription medications, including Chantix.
- Formulary Coverage: Each Part D plan has its own list of covered drugs, known as a formulary. Chantix may be included on the formulary of many Medicare Part D plans, but it is important to check the specific plan to determine its coverage. The formulary can change annually, so it’s advisable to review the plan’s formulary for the most up-to-date information.
- Prior Authorization: Some Part D plans may require prior authorization before covering Chantix. This means that the prescribing physician needs to provide additional information about the patient’s medical condition and the necessity of Chantix for smoking cessation.
- Cost Sharing: Medicare Part D plans typically involve cost-sharing arrangements, which include copayments or coinsurance. The specific out-of-pocket costs for Chantix will depend on the particular Part D plan. It’s advisable to compare different plans to find the one that offers the most favorable coverage and cost-sharing for Chantix.
- Medicare Advantage Plans: Alternatively, individuals who are enrolled in a Medicare Advantage (Part C) plan may also have coverage for Chantix. These plans are offered by private insurers approved by Medicare and provide the same benefits as Original Medicare (Part A and Part B) along with additional benefits, which may include prescription drug coverage.
an Medicare coverage for Chantix vary depending on the state?
No, Medicare coverage for Chantix does not vary depending on the state. Medicare is a federal program that provides consistent coverage guidelines across the United States. The coverage for Chantix under Medicare Part D or Medicare Advantage plans should generally be the same regardless of the state in which you reside.
Is there a specific age requirement for Medicare coverage of Chantix?
No, there is no specific age requirement for Medicare coverage of Chantix. As long as you are eligible for Medicare and have prescription drug coverage through Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage, you may be eligible for coverage of Chantix, regardless of your age.
Does Medicare cover generic versions of Chantix?
Yes, Medicare Part D and Medicare Advantage plans typically cover generic versions of Chantix when they are available. Generic drugs contain the same active ingredients as their brand-name counterparts and are generally more affordable. If a generic version of Chantix is available, it is advisable to check the formulary of your specific plan to determine its coverage and any associated cost-sharing requirements.
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Justin Wright
Licensed Insurance Agent
Justin Wright has been a licensed insurance broker for over 9 years. After graduating from Southeastern Seminary with a Masters in Philosophy, Justin started his career as a professor, teaching Philosophy and Ethics. Later, Justin obtained both his Property & Casualty license and his Life and Health license and began working for State Farm and Allstate. In 2020, Justin began working as an i...
Licensed Insurance Agent
Editorial Guidelines: We are a free online resource for anyone interested in learning more about auto insurance. Our goal is to be an objective, third-party resource for everything auto insurance related. We update our site regularly, and all content is reviewed by auto insurance experts.