As a prescription drug for pain relief, Vicodin is a combination of a narcotic, hydrocodone, and non-narcotic, acetaminophen anodyne. It is an effective and common prescription for pain relief, but can be dangerous and addictive in large doses. Your Medicare plan may impose certain limitations on how much can be prescribed and in what settings it can be administered for coverage.

Understanding Vicodin and Common Uses

Whether sold under the brand name Vicodin or by its generic name of hydrocodone/acetaminophen, this medicine is listed as a schedule II controlled substance in the United States. Because hydrocodone is an opioid, the risk of abuse or complications from side effects requires careful administration and regulation.

Many doctors prescribe this medicine for the treatment of acute or chronic pain due to certain medical conditions. It’s also common to prescribe Vicodin for post-surgical pain management. Generally speaking, pain-relieving effects are felt within 20 to 30 minutes of ingestion and may last for up to 8 hours.

Concerns and Risk Factors for Vicodin Use

The Centers for Disease Control and Prevention (CDC) list opioids as potent but important medicines for the treatment of pain. When taken according to the prescribed dosage, Vicodin can provide safe and effective pain relief. However, because side effects can be severe and abuse can be life-threatening, it’s necessary to understand the symptoms.

Side effects may include:

  • Dizziness or a feeling of lightheadedness.
  • Euphoric sensation or sedation.
  • Vomiting or nausea, as well as a headache.
  • Respiratory distress.
  • Hearing impairment.
  • Itching or skin rash.

Symptoms of an overdose may include:

  • Shallow or difficulty breathing.
  • Inability to maintain consciousness.
  • Limp muscles and loss of function.
  • Poor circulation which results in slow heart rate, low blood pressure and cold skin.
  • Extreme symptoms may include loss of heart function, as well as liver or kidney failure.

If you’re prescribed Vicodin to treat pain, discuss any concerns with your doctor and inform them of any prior sensitivity to opiates. If you’re currently prescribed any other narcotic medicines, make sure your doctor is aware as this can lead to serious health complications.

Medicare Coverage for Vicodin

Medication that is considered a self-administered drug to be taken at home but given in an outpatient setting is generally not covered by Medicare Part B. If you receive Vicodin while being treated as an inpatient at the hospital, Medicare Part A may provide coverage once any copayments, coinsurance, and deductibles have been met.

A Medicare Part D Prescription Drug Plan (PDP) can help you lower your out-of-pocket drug costs. PDPs can vary in coverage and cost. Each drug plan will have a unique formulary, or list of covered medications. They will also have their own tiers of pricing based on whether you purchase generic or brand-name medications and if you are visiting one of their network pharmacies or mail order services. When available, a generic version of a brand name drug like Vicodin may help lower your out-of-pocket costs.

Medicare Advantage plans that offer prescription drug coverage (MA-PDs) will also have their own formulary and pricing. Check with your plan for specific costs. Formularies and cost-sharing amounts for both a Medicare Part D Prescription Drug Plan and Medicare Advantage plan with prescription drug coverage may be updated yearly with changes to the list of medications they cover. It’s important to stay up-to-date on these changes if you anticipate a recurring need for certain medications, such as Vicodin.

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