Zolpidem is the generic form of the well-known medication Ambien. This prescription medication is commonly used by individuals who have difficulty sleeping, especially those with insomnia. In particular, Zolpidem is beneficial for individuals who wake frequently during the night and have difficulty falling back asleep. If you have a Medicare Part D or Medicare Advantage Plan, your Medicare benefits may cover the costs of this medication with little out-of-pocket cost required.

What is Zolpidem and How Does it Work?

The therapeutic class of Zolpidem, which is the category a drug is placed in based on the way it works in the body, is sedative-hypnotics. Now, this does not mean that the drug causes you to become hypnotized, but it does have a sedative effect on the central nervous system (CNS). This CNS depression is caused by the binding to GABA receptors.

GABA, which is short for gamma aminobutyric acid, occurs naturally in the body. When this amino acid binds to GABA receptors, it acts as an inhibitory neurotransmitter and blocks certain brain signals, decreasing nervous system activity. The reduced sensory stimulation provides a calming feeling on the body, helping to reduce anxiety, stress, depression, and sleep problems.
Zolpidem stimulates the activity of GABA, causing it to bind the GABA receptors more readily. This allows it to have an identical effect but at a larger magnitude. The relaxation effect that occurs after taking Zolpidem can help individuals get to sleep and stay asleep.

Zolpidem is available in both oral spray and tablet form, with tablets being most used most often. Tablets come in instant-release, extended-release, and sublingual tablets. Since the area under the tongue receives a large amount of blood flow, the sublingual tablets are absorbed very quickly.
Because of this, the sublingual and immediate-release tablets are often used for individuals that have trouble falling asleep initially. If you can usually fall asleep, but you find yourself waking up often in the middle of the night and have trouble falling back asleep, taking an extended-release tablet may be a better option for you.

Zolpidem is associated with some minor potential side effects, such as headache, drowsiness, diarrhea, grogginess, and dry mouth. These side effects often subside within just a few days or weeks. More serious side effects can include allergic reactions, onset of or worsening depression, participating in activities while you are sleeping like driving or talking on the phone, or hallucinations. If you do suffer from any of these side effects and they do not subside quickly, you should contact your provider.

Do Medicare Benefits Cover Zolpidem?

Ambien, the brand name drug of Zolpidem, used to be extensively covered by Medicare Part D and Medicare Advantage plans with prescription drug coverage. However, coverage for this medication has decreased recently due to the availability of Zolpidem as a cheaper, generic option.

To obtain coverage for Zolpidem, you will be required to have either a Medicare Part D or Medicare Advantage plan that includes prescription drug benefits. Original Medicare Part A and Part B do not include prescription drug coverage, so many Medicare recipients enroll in a stand-alone Prescription Drug Plan. These plans require certain out-of-pocket costs depending on your specific plan. Most Part D plans include a deductible. This amount may be $0 in some cases, and there is an annual cap of $415 for 2019. Once your deductible has been met, a flat-fee copayment or a coinsurance is required depending on the medication.

Medicare Advantage plans are another option that may provide drug coverage. These plans are managed by private insurance companies, so each plan varies significantly in associated costs. Many of these plans require that you visit providers and pharmacies within your specific plan’s network. Visiting pharmacies out of network can result in significant out-of-pocket charges. Plans will vary in cost and coverage. Compare your options before enrolling.

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