Coumadin, a blood thinner, is prescribed to help reduce your risk of developing a blood clot. Medicare benefits from a Part D Prescription Drug Plan that cover this medication can reduce your out-of-pocket expenses if your physician prescribes Coumadin.

Conditions Treated by Coumadin

Blood clots can develop in the heart, lungs or in veins and arteries throughout the body. These clots can cause severe health complications and can be fatal in certain circumstances. A blood thinner like Coumadin, which can also be known by its generic name of warfarin, may be prescribed after an open-heart surgery or heart attack. It may also be prescribed if there are blood clots present or if you have had a blood clot before.

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are medical conditions that describe where blood clots form and how they behave in that location of the body. As the name suggests, DVTs develop in the deep veins within the body, typically in the legs and thighs. A clot that moves through the bloodstream and enters the lung becomes a PE.

Risk factors for developing blood clots include:

  • Tissue trauma to vein
  • Smoking tobacco
  • Long periods of inactivity
  • Pregnancy and post-partum for up to 6 weeks
  • Excessive weight or weight gain
  • Preexisting health conditions like diabetes or heart disease
  • Certain genetic blood disorders
  • Some prescription medications

Benefits and Risks Associated with Coumadin

Blood clots that enter into the heart and lungs can worsen rapidly and become fatal, which is why blood thinners like Coumadin are used to prevent them from developing in other parts of the body first.

Although it can be common with any prescription medication administered by mouth to experience some digestive adjustment or headaches at first, any persistent or intense discomfort should be reported to your prescribing physician immediately.

Taking blood thinners means you are at risk of excessive bleeding even from small scrapes or nicks to your skin. Your doctor may advise several lifestyle changes while you are taking Coumadin in order to help you lower your risk of injury.

It’s also extremely important to tell other healthcare providers that you are taking a blood thinner, especially a dentist. You may need to schedule treatment around when you can stop taking Coumadin so that you can avoid complications.

Medicare Coverage for Coumadin

When you have prescription drug coverage through a Part D plan, your benefits will be determined by your plan’s formulary and the covered medications tier assignment. You can enroll in a stand-along Prescription Drug Plan if you have Original Medicare, or you may choose to enroll in a Medicare Advantage (MA) plan. Medicare Advantage plans will include your Part A and Part B benefits along with additional coverage. Many MA plans include prescription drug coverage. Since there is not a standardized process between different insurance carriers, medications like Coumadin may be covered by one plan and not another. These formularies are also updated at least once a year, so coverage rules can change whether a medication continues to be listed or under which tier it’s classified.

When a drug is covered by Medicare benefits from a Part D plan, its qualifying use is restricted to FDA-approved guidelines. Off-label use, which is when a drug is prescribed to treat conditions it has not been previously approved by the FDA to treat, is usually not covered by Medicare plans. If your doctor prescribes Coumadin for off-label use, you may be able to appeal a denial of coverage if it can be proved to be the only effective medication for your needs.

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