Does Medicare Cover Trelegy?
Chronic obstructive pulmonary disease (COPD) is an inflammatory lung condition that affects almost 16 million Americans. Women are diagnosed with COPD more often than men, and the condition is a major cause of disability. People over the age of 40 are also more commonly diagnosed with COPD.
You can manage COPD and other lung-related conditions with a prescription medication called Trelegy. And the good news is that 96% of Medicare prescription drug plans cover Trelegy. Read on to learn more about Trelegy and Medicare coverage in this post.
Key takeaways:
Trelegy is a prescription medication delivered via an inhaler to manage symptoms of COPD.
96% of Medicare prescription drug plans cover Trelegy.
Copays range from $9-$11 before you meet your deductible and $0 to $756 after you meet your deductible. This post-deductible range includes costs in the coverage gap phase.
What is Trelegy?
Trelegy is a prescription medication delivered via an inhaler. Doctors prescribe Trelegy to treat COPD and sometimes asthma.
What is chronic obstructive pulmonary disease (COPD)?
COPD occurs when you have trouble breathing because your airways become obstructed through inflammation or damage. Smoking, chronic bronchitis, emphysema are two common causes of COPD.
Signs and symptoms of COPD include:
Chronic coughing
Excessive mucus
Wheezing and shortness of breath
Chest tightness
Frequent respiratory infections
How Trelegy helps COPD
There are three active ingredients in Trelegy: fluticasone, umeclidinium, and vilanterol. Each of these components work together to help manage symptoms. The combination of these ingredients reduce inflammation, relax the muscles around the airways, and ease airway constriction to help you breathe easier.
Medicare coverage of Trelegy
Medicare Part D covers Trelegy if your doctor recommends you use the inhaler to treat COPD. Your specific costs depend on what prescription drug plan you have. Here’s an estimate of what you may pay for Trelegy with Medicare:
Before you meet your drug plan’s deductible: $9-$11
After you meet your drug plan’s deductible: $0-$756
The range is much higher in the post-deductible phase because it accounts for the cost if you enter a coverage gap for your prescription drugs. During the coverage gap stage, there’s a temporary limit on how much your drug plan covers for medications, so you may pay more for Trelegy. In 2024, you’ll reach the coverage gap once you and your plan spend $5,030 on covered drugs. However, you won’t pay more than 25% of the cost of your plan’s covered brand-name prescription drugs. This discount may be lower depending on your drug plan—review your plan’s summary of benefits or contact your insurance for more information.
The key to Medicare savings is finding a good prescription drug plan that covers your needs and reduces your copays and coinsurance. Call us to get help comparing your options and enrolling in a plan that minimizes your costs.
How else Medicare can cover COPD management and treatment
There are other services you can receive Medicare coverage for if you’ve been diagnosed with COPD. Also, if you’re under the age of 65 and are considered disabled due to COPD, you’re eligible to enroll in Medicare after receiving Social Security Disability Insurance for 24 months.
Here’s a list of services Medicare covers for COPD:
Doctor visits
Durable medical equipment, if you qualify
Yearly lung cancer screenings if you have a history of smoking
Other medications to help ease your symptoms
Finding the right prescription drug plan
Prescription drug plans are an important part of your Medicare coverage, but Original Medicare doesn’t include drug coverage. You can get Part D (prescription drug) coverage through a separate plan or through a Medicare Advantage plan. There are a lot of different prescription drug plans and Medicare Advantage plans and each one is different. Furthermore, plan availability depends on where you live. We always recommend working with a licensed Medicare agent to compare plans and find one that best fits your needs. Call an agent at 855-900-2427 or schedule a time to chat to get help.