Type 2 diabetes is the most common form of diabetes, affecting millions of Americans. The causes of type 2 diabetes can vary, but lifestyle choices like excess weight, smoking, and physical inactivity, can contribute to the disease. In type 2 diabetes, the body develops a resistance to insulin, impacting the body’s ability to regulate insulin production and utilize insulin properly. Type 2 diabetes tends to affect older adults, with 25% of adults 65 or older living with the disease.

When type 2 diabetes goes untreated, it can lead to serious complications such as heart disease, stroke, kidney disease, hypertension, and amputation. Although changes to diet and exercise are generally recommended for patients with type 2 diabetes, many physicians prescribe medications to seniors to help manage their disease. If you qualify for Medicare, your coverage can help lower your out-of-pocket costs for drugs like Victoza (liraglutide) that can help provide relief and manage your symptoms..

How Does Victoza Work?

Victoza is an injectable non-insulin medication that lowers blood sugar and helps prevent major cardiovascular events. It is usually taken once daily by patients with type 2 diabetes. Because insulin production and regulation can be directly affected by diet, you need to know how and when to take any type of type 2 diabetes medication and follow strict guidelines. Taking Victoza may change the way you have to plan meals and whether or not you need to take insulin at mealtimes. You may also experience side effects when taking Victoza, so it’s best to understand the risks and benefits. It should also be noted that side effects observed in medical studies may or may not affect you in the same manner, so always let your doctor know right away if you’re experiencing new or worsening symptoms or side effects.

Does Medicare Cover Victoza?

Because Victoza is a prescription medication, it is usually not covered by Medicare Part A or Part B. Part D prescription drug coverage may be able to help pay for prescription medications, including Victoza. If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP). Many Medicare recipients choose to get their Part A and Part B benefits through a Medicare Advantage plan offered by a private insurance company. Medicare Advantage plans are required to provide at least the same benefits as Original Medicare, but many offer additional benefits, including prescription drug coverage.

Part D drug plans can differ. Each plan will have its own formulary, or list of covered medications. In most cases, Victoza is covered under Medicare Part D because it is not an over-the-counter medication or a medical treatment that falls under exclusions of the Medicare insurance program.

What is the Cost of Victoza With Medicare Part D?
If you’re prescribed Victoza, your out-of-pocket expenses will be based on your Medicare drug coverage plan and your plan’s provider. Drug plans have tiers of pricing based on brand-name or generic medications, and whether you visit a pharmacy within your plan’s network. In some cases, Victoza will be covered fully for Medicare insurance recipients when prescribed as a medically necessary treatment, while in others, a copayment will be required.

Victoza and Off-Label Usage
It’s important to point out that Victoza may have some effect on weight control, but this is not its primary purpose. Under Medicare Part D, medications used specifically for weight control are not covered, but because this is not the primary function of the medication, your prescription coverage should not be affected. With this stated, you should never take a prescription medication outside of your physician’s orders. Even if you experience weight loss as the result of taking Victoza, off-label usage should not be undertaken unless your doctor provides direction. Taking medications improperly, especially when they involve insulin regulation and absorption, could lead to very serious health consequences.

Finally, it’s a good idea to discuss all treatment options available with your doctor when it comes to managing type 2 diabetes. Your physician can help determine your unique risks, complications and considerations in order to create a treatment plan that meets your specific needs.

Related articles:

Medicare Part C

New to Medicare