Lidocaine is a popular pain-relieving aid your doctor can prescribe for minor pain. Medicare recipients could pay very little or nothing for this medication under their insurance. We’ll talk about what Lidocaine is, what Medicare benefits could cover it, and how much the typical cost is below.

What is Lidocaine?

Lidocaine is an ointment or topical jelly. Doctors can apply it to different parts of the body before a procedure to cause loss of feeling or numbness. Another popular use is to relieve itching and pain caused by a host of minor medical issues.

Lidocaine is popular for relieving the itching and burning associated with minor burns, sunburn, poison ivy, insect stings, poison oak, insect bites, small cuts, poison sumac, and scratches. A form of Lidocaine is called Xylocaine, and this is a jelly doctors use to treat urethral inflammation. If medical professionals are going to intubate you, they use Xylocaine to lubricate your throat, mouth, and nose.

You can get a viscous topical solution of Lidocaine to treat minor sores in your mouth and throat. This solution can also calm your gag reflex during dental impression taking or x-rays. The Lidocaine skin patch can help reduce the burning pain associated with shingles or herpes.

This medication is available by prescription only. It’s part of the local anesthetic family. It works by preventing your nerve endings from sending pain signals to your skin. This type of medication isn’t strong enough to render you unconscious like stronger alternatives do before you to into surgery. Your doctor can prescribe you the following forms of Lidocaine:

  • Cream
  • Gel or Jelly
  • Lotion
  • Ointment
  • Patch (Extended Release)
  • Powder
  • Solution
  • Spray
  • Swab

Do Medicare Benefits Cover Lidocaine

Medicare recipients that have Part D prescription drug coverage may have coverage for Lidocaine prescribed by your doctor. To keep costs affordable, many Part D plans split their prescription drug coverage into several tiers. There is no one way to divide your coverage into these tiers, and it’ll vary from plan to plan. Usually, a drug slated into a lower tier will be less expensive than a drug in a higher tier. Most tiers are as follows:

  • First Tier – The first tier has the lowest copayment amount because it’s usually generic prescription drugs.
  • Second Tier – The second tier is the preferred drug coverage tier. Many brand-name prescription drugs fall into this category.
  • Third Tier – The third tier is the non-preferred drug coverage tier. It also has brand-name prescription drugs.
  • Specialty Tier – The fourth tier has the highest copayment for your prescriptions. This tier gets reserved for very expensive prescription drugs.

Medicare typically puts Lidocaine as a Tier Two or Three drug, depending on the form. For example, it covers Lidocaine 5 ointment, but it rarely covers the patches. This means that it can be slightly more expensive if you have to pay for it out of pocket. You can also ask about less expensive generic brands.

Additionally, most Medicare benefits restrict how much Lidocaine you can get in a single fill. If you need more than the benefits allow, they won’t cover your prescription. It typically requires prior authorization as well. This means your doctor will have to fill out paperwork that explains why you need Lidocaine with the correct CTP codes and submits it to the insurance company. The copay usually ranges between $0 and $10.

Medicare recipients can get their Lidocaine prescription paid for by their insurance if they have Part D, depending on the Lidocaine’s form. Always check with your provider and your insurance company before you fill your prescriptions to see if you have a copay. If your plan doesn’t cover it, ask about generic options.

Related articles:

Does Medicare Cover Lidocaine Patches?(Opens in a new browser tab)

Does Medigap Cover Prescription Drugs? (Opens in a new browser tab)