Does Medicare Cover Famotidine?

Health Line

18 hours ago

Famotidine is a generic drug that doctors prescribe to treat conditions related to excess stomach acid production, such as stomach ulcers and gastroesophageal reflux disease (GERD).
It's available in over-the-counter (OTC) and prescription strengths, and companies may sell it under the brand names Pepcid AC or Zantac 360.
Medicare Part D drug plans generally cover prescription famotidine, though there may be some variation based on the specific plan.
Original Medicare doesn't cover OTC famotidine. However, some Medicare Advantage (Part C) plans may include OTC benefits that members can use toward this medication.
Part D coverage for famotidine
Medicare-approved private insurance companies sell Part D prescription drug plans. If you have Original Medicare, you can buy a stand-alone Part D plan, whereas people with Medicare Advantage plans often have Part D plans in their coverage.
Each plan has a formulary. This is a list of medications that the plan covers. Part D plans generally include prescription famotidine in their formularies.
However, since specifics vary by insurance carrier, plan, and location, there's no guarantee that all plans include coverage for famotidine.
To learn whether your Medicare drug plan includes coverage for famotidine, consult your plan details or a representative.
Over-the-counter famotidine and Medicare
Many Medicare Advantage plans include coverage for OTC products as part of their additional benefits. If your Medicare Advantage plan includes OTC benefits, you can likely use them to buy famotidine.
Generally, with OTC benefits, members can get a benefits card that works like a debit card. The plan adds funds to the card at regular intervals, and you can use it at participating retailers to buy eligible products.
The specific retailer and product lists may depend on the plan, but Walgreens, for example, offers various famotidine products in different strengths and quantities through its OTC benefits program.
Famotidine cost with Medicare
The cost of famotidine may depend on its strength, quantity, form, and whether it's a generic or brand-name product.
Formularies place covered drugs into tiers. These tiers typically correspond with a drug's cost, with lower tier drugs often carrying lower copayments or coinsurance.
A plan's formulary may cover multiple versions of famotidine. If so, the oral tablet form is likely to be a tier 1 drug, whereas the oral suspension may be a tier 4 drug. However, this may not be the case for all plans that cover famotidine.