If you have been diagnosed with diabetes mellitus type 2, your doctor may recommend certain medications to help you control your condition. Sitagliptin, which is often sold under the brand name Januvia, is a common choice. Understanding how this medication may work for you can help you determine whether or not your Medicare insurance will provide coverage.

How Januvia Works

The Mayo Clinic describes type 2 diabetes as a condition that impacts your body’s ability to produce insulin in response to glucose levels in your blood stream. As a medication used to treat this condition, Januvia prevents enzymes from breaking down certain gastrointestinal hormones that typically trigger the release of insulin after a meal is consumed. By leaving more of these GI hormones intact, insulin secretion increases and the pancreas releases less glucagon, which helps to keep blood glucose levels within a normal range.

Januvia is manufactured by Merck & Co. as a round, beige tablet and has the number 277 imprinted on one side. When prescribed, it is taken once a day by mouth. Talk to your doctor or pharmacist about what time of day is best to take this medication, as well as if you should be timing your dose with respect to when you eat meals or snacks.

Side Effects and Risks Associated with Januvia

As with any prescription medication, some patients may experience mild, moderate or severe reactions. Your doctor or prescriber should be made aware of any history of medication reactions or chronic diseases you have experienced beforehand. Possible side effects may include:

  • Allergic reaction. Trouble breathing or swallowing, skin reactions such as hives, rashes, or swelling around the mouth and face are all signs of an allergic reaction.
  • Pancreatitis. Symptoms of pancreatitis can involve pain in the abdomen and back that is severe and does not go away. It may be accompanied by vomiting.
  • Other symptoms. Some people have experienced upper respiratory issues while taking Januvia, including infection, sore throat and a runny or stuffy nose. Headaches have also been reported. Joint pain or skin reactions such as blisters have also been reported.

Communicating with your doctor or prescriber about anything you suspect is a symptom or side effect of taking Januvia will help you avoid any long-term complications. Blood tests to observe kidney function may also be performed when taking Januvia. If you’re taking any other medications to treat type 2 diabetes, talk to your doctor about whether or not those should be adjusted while also taking Januvia.

Medicare Coverage for Januvia

Original Medicare Part A and Part B only cover the administration of prescription medications when it occurs during a hospital stay or outpatient service. Prescriptions that are taken at home are not included in these benefits.

Medicare coverage through Part D prescription drug coverage does help pay for medications taken at home to treat medical conditions, which can include many choices for Type 2 diabetes patients. If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP). Many Medicare Advantage plans offer prescription drug coverage in addition to your Part A and Part B benefits.

Because the formulary, or list of covered drugs, for each prescription drug plan can vary, check with your plan to make sure Januvia will be covered. Costs will differ, as well. Medicare Prescription Drug Plans and Medicare Advantage plans with prescription drug coverage (MA-PDs) may classify approved medications at differently tiered price levels to help control costs for patients. Rules regarding copayment, coinsurance, yearly deductibles and limits also differ between each plan. When available, generic versions of name-brand medications can also help reduce out of pocket expenses.

Related articles:

Medicare Part C

New to Medicare