Does Medicare Cover Aricept?

Alzheimer’s Disease is the most common form of dementia, affecting approximately 5.7 million Americans. According to the Alzheimer’s Association, someone develops the disease every 65 seconds. With no current cure for Alzheimer’s, treatment options are extremely important for those living with memory and cognitive function loss that affects their daily lives. Aricept, also known in generic form as Donepezil Hydrochloride, has been approved by the U.S. Food and Drug Administration (FDA) to treat cognitive symptoms, including memory loss, confusion, and problems with judgment, language, thinking and reasoning. Aricept is a cholinesterase inhibitor and is approved to treat all stages of Alzheimer’s.

The greatest known risk factor for Alzheimer’s Disease is age, and since most Alzheimer’s patients are 65 years of age or older, we should understand how Medicare can help cover the cost of Aricept. Aricept is a drug prescribed by a physician and may be covered by a Medicare Part D plan if you choose to enroll in prescription drug coverage.

Medicare Part D Options

There are options to consider if you need prescription drug coverage. Medicare recipients have the choice of getting their Part A and Part B benefits through:

  • Original Medicare
  • Medicare Advantage (Part C)

Original Medicare is administered by the federal government and includes Part A (hospital insurance) and Part B (medical insurance) benefits. Most people receive premium-free Part A because they have paid taxes for a certain period of time while working. Part B will generally have a monthly premium and annual deductible you will have to pay. Even though Original Medicare covers the costs of many services and supplies, some people choose to purchase a supplemental insurance policy (Medigap) to help pay for some of the out-of-pocket expenses, including deductibles, coinsurance, or copayments. Unfortunately, Part A, Part B, and Medigap do NOT include prescription drug coverage.

If you have Original Medicare, you may want to consider enrolling in a stand-alone Prescription Drug Plan (PDP). Prescription Drug Plans are sold by private insurance companies approved by Medicare. If you do not enroll in a PDP when you are first eligible for Medicare and decide to enroll at a later date, you may incur a late enrollment penalty. Each PDP will offer different costs and have its own formulary, or list of covered drugs, so compare plans carefully before you enroll. If you are already taking Aricept, you can check the formularies of those plans you are considering to check coverage and cost.

Medicare Advantage (MA) plans are offered by private insurance companies that contract with Medicare to provide your Part A and Part B benefits. MA plans are required to provide at least the same benefits as Original Medicare, but many offer additional coverage, including dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage (MA-PDs) may have different formularies and costs and may include a specific network of pharmacies you need to visit in order to be covered.

While most prescription drug coverage will help pay for the cost of Aricept, every PDP or MA-PD may have a different “tier” of pricing based on generic, brand-name, or mail order prescriptions. If you enroll in prescription drug coverage, you will likely have to pay a monthly premium, annual deductible, and copayment or coinsurance for your medications. The costs can vary depending on the plan you choose and whether you receive Extra Help paying for Medicare Part D costs.