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Medicare Drug Coverage and Alzheimer’s

Medicare pays for most outpatient prescription drugs. These include drugs to treat Alzheimer’s disease. In general, you get this coverage through private drug insurance plans, called Part D plans. Each plan covers different drugs and has different costs.

All Medicare drug plans must include certain types of prescription drugs used to treat Alzheimer’s. Each plan must cover at least two drugs in two categories that:

  1. Raise the levels of brain chemicals to aid memory and judgment, called cholinesterase inhibitors, and
  2. Help improve memory, attention, reason and language, calledmemantine.

Can Medicare drug plans charge different amounts for Alzheimer’s drugs?

Yes. Like most other drugs under Medicare Part D, the cost you pay for Alzheimer’s drugs varies by plan.

Medicare requires each drug plan to cover certain types of Alzheimer’s drugs. But each plan can decide on its own what to charge you. Make sure you know what copayments the different plans charge for the prescription drugs you take. Then choose the plan the best meets your needs.

You can get personal help reviewing your drug plan options.

Do Medicare drug plans restrict which drugs they cover?

Yes. A Medicare drug plan can make it harder for people to get certain drugs, even people with Alzheimer’s. This is true even if the drug is on the plan’s drug list, or formulary. Medicare does this in different ways and for different reasons. To learn about these restrictions, see Special Rules and Limits.

If your plan does not cover a drug you need or has limits on that drug, you and your doctor can ask the plan for an exception to get the plan to cover it. And if the plan says no, you can appeal the plan’s decision.

My husband has Alzheimer’s and depression. Will Medicare also cover his anti-depressants?

Yes. Medicare drug plans must cover “all or substantially all” anti-depressants, antipsychotics, and anticonvulsants. Many Alzheimer’s patients need these medicines to treat depression or anxiety.

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