Otezla Now Approved for Multiple Conditions, Medicare Coverage Varies
Otezla (apremilast) has been approved for treating several conditions, including plaque psoriasis, psoriatic arthritis, and mouth ulcers in Behcet disease. Medicare, including Part D, covers such prescription medications, but costs vary based on the chosen plan and location. Let's explore the coverage and costs.
Medicare, including Part D, covers prescription drugs, including Otezla. However, costs can differ significantly based on the chosen plan and location. A typical Medicare plan includes a premium, deductible, copayment, and coinsurance. Once out-of-pocket costs reach $2,000, beneficiaries enter catastrophic coverage, paying nothing for prescriptions for the rest of the year. In 2026, this threshold may rise to $2,100.
Medicare Advantage plans often include prescription drug coverage (Part D). While these plans typically cover Otezla, coverage and costs depend on the specific plan's formulary. Beneficiaries should check their plan's formulary to confirm Otezla coverage and associated costs, such as premiums, deductibles, copayments, and coinsurance. Original Medicare (parts A and B) does not typically cover prescription medications taken at home.
Otezla's approval for treating multiple conditions is good news for Medicare beneficiaries. However, costs vary based on the chosen Medicare plan. Beneficiaries should review their plan's formulary to confirm Otezla coverage and associated costs. The out-of-pocket threshold for catastrophic coverage is set to rise in 2026, providing more financial relief for beneficiaries with high prescription costs.
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