Monday, February 26, 2024

Is Belsomra Covered By Medicare

Don't Miss

What If I Can’t Afford Belsomra

Merck Patient Assistance Program Instructional Video Enrollment Form

Through the Merck Helps Patient Assistance program, the manufacturer of Belsomra provides financial assistance for individuals who can’t afford Belsomra. To qualify you must:

  • Be a resident of the United States
  • Have received a prescription for Belsomra from a doctor or other licensed prescriber in the United States
  • Prove that your Medicare plan will not pay for the drug and that you are ineligible for other assistance programs
  • Show demonstrated financial need

Does Medicare Cover Belsomra And How Much Does It Cost

Depending on your Medicare coverage, Belsomra prices will vary. You can pay a discounted price of $350.18 for 1, 30 Tablets Tablet when you use SingleCare’s savings card. Use SingleCare’s app or website to search for the pharmacy with the lowest cash price for Belsomra. Then, ask your pharmacist to compare the cost with different payment options. When weighing the costs with Medicare versus those with SingleCare, you might be surprised to find that SingleCare savings are often greater than savings with Medicare.

Get Help Managing Your Medications

If youre taking a number of medications prescribed by more than 1 doctor, you may be eligible to take advantage of . Through this program, you can meet 1-on-1 with a doctor or pharmacist to learn more about your medicines and how they work, ask questions about side effects or interactions with other medications and look for opportunities to lower your costs.

Also Check: How To Apply For Medicare Through Spouse

Cost Information For Essential And Net Results

For members on the Essential Medication List , if request for a non-formulary medication is approved, these cost levels or “tiers” will apply:

Essential 5 Tier = Tier 5Essential 6 Tier = Tier 6

For members on the Net Results Medication List , if the request for a non-formulary medication is approved, these cost levels or “tiers” will apply:

Non-specialty medication = Tier 4Specialty medication = Tier 5

Does Belsomra Treat Anxiety

No, Belsomra isnt approved by the Food and Drug Administration to treat anxiety. Its FDA-approved to treat only insomnia in adults.

Since Belsomra was approved, some people taking the drug have reported anxiety. But it isnt known if the drug was the cause. Its possible that the anxiety was linked to sleep-related side effects such as sleep paralysis or hallucinations.*

A clinical study looked at suvorexant in hospitalized people with insomnia and mental illness. After 8 weeks of treatment, reports showed that suvorexant helped improve sleep quality and reduce the severity of anxiety. But more research is needed to evaluate the use of suvorexant for anxiety.

If you have questions about anxiety treatments, talk with your doctor.

* For more information, see Side effect details in the Belsomra side effects section above.

You May Like: Does Medicare Cover Biologics For Ra

What Medicaid Helps Pay For

If you have Medicare and qualify for full Medicaid coverage:

  • You’ll automatically get Extra Help with your drug costs. Learn more about Extra Help.
  • Medicaid may pay for other drugs and services that Medicare doesn’t cover.
  • Will I Need To Use This Drug Long Term

    Possibly. Belsomra may be used as a short- or long-term treatment. If your insomnia doesnt ease within 7 to 10 days of treatment with Belsomra, talk with your doctor. They may check you for other medical conditions that can cause or worsen insomnia.

    If you and your doctor determine that Belsomra is safe and effective for you, they may recommend that you continue taking it long term.

    Recommended Reading: Do I Really Need A Medicare Supplement

    What Is A Prior Authorization And How Do I Get One

    A Prior Authorization is a request from your provider for Health First Colorado to cover a drug not listed on the Preferred Drug List or otherwise listed on Appendix P of the Preferred Drug List. Your provider will submit the prior authorization request for you. After your prior authorization request is reviewed you and your provider will find out Health First Colorado’s decision. If the criteria are not met, the doctor can re-submit with updated information, or appeal the decision to Health First Colorado’s Pharmacy Benefits section for further review.

    Each request is processed within 24 hours, and most phone requests are given the approval/denial decision immediately upon submission. If you have an emergency, your provider can get a 72-hour emergency supply of the drug you need.

    Colorado Pharmacy Call Center phone number: | Colorado Pharmacy Call Center Fax Number: 800-424-5881

    How Much Does Belsomra Cost Without Insurance

    If you’re paying for your Belsomra prescription without insurance, you should expect to pay approximately $574.07 for 1, 30 Tablets Tablet. Even if you don’t have health insurance coverage, you can use SingleCare Belsomra free coupons to receive instant savings off your medications, including brand-name, generic, and over-the-counter products.

    You May Like: Who Pays For Medicare Part B Premiums

    Table Of Drugs With Limited Or No Coverage

    Drug Type

    All: Not covered please see the non-FDA approved medication and product list for specific medications that aren’t covered

    Initial fill of immediate-release opioid All: Limited to maximum of 7 days for initial fill. If this is not the first fill, but Blue Cross NC does not have the patient’s claims history, use this IR Opioid QL Criteria and IR Opioid QL Fax Form .
    Prescription medications with over-the-counter alternatives Please see member guide for coverage.Not covered as a standard benefit. Please see list for specific drugs that are not covered.
    Medications used solely for weight loss Please see member guide for coverage.Not covered as a standard benefit. Please see list for specific drugs that are not covered.
    High Dollar Verification Single claims over $10,000 require prior authorization . Criteria information can be found here, and fax submission information can be found by clicking here.

    How To Save On Belsomra

    Merck, the manufacturer of Belsomra, has a Belsomra manufacturer coupon and a limited 10-day free trial promotion. Contact Merck for more information. Merck Patient Assistance Program and Merck Connect are Belsomra patient assistance plans that also provide savings options for eligible patients who can’t afford Belsomra. If you dont meet the patient assistance eligibility requirements, you can always use and reuse a Belsomra savings coupon from SingleCare.

    Don’t Miss: How Many Mastectomy Bras Are Covered By Medicare

    Belsomra Withdrawal And Dependence

    In clinical studies, there were no reports of physical drug dependence or withdrawal with long-term use of Belsomra.

    But Belsomra is classified as a Schedule IV controlled substance because of possible misuse. The risk is increased in people who had or have a substance use disorder.

    Belsomra is considered a central nervous system depressant, which is a drug that slows down the activity of your brain and nervous system. Like other CNS depressants, Belsomra may cause psychologically addiction in some people.

    If you have concerns about taking Belsomra, talk with your doctor.

    You should take Belsomra according to the instructions your doctor gives you.

    Belsomra comes as an oral tablet that you swallow.

    Am I Eligible For The Belsomra Patient Assistance Program

    We will review your application to determine whether you are eligible for the Belsomra patient assistance program. Each program has its eligibility criteria which are set by the pharmaceutical companies, however, the factors considered by most programs are:

    • I am a permanent, legal resident of the United States or Puerto Rico
    • I am uninsured or my insurance doesnt cover my medication
    • I meet certain income eligibility requirements

    Read Also: Are Hearing Aid Batteries Covered By Medicare

    Is Belsomra A Tier 3 Drug

    Medicare prescription plans classify drugs into tiers to determine out-of-pocket pricing. Belsomra will fall under Tier 3 or 4, which are reserved for drugs that don’t have generic equivalents.

    Drug plans have the right to classify certain medications as preferred. These medications incur lower out-of-pocket costs than non-preferred drugs. Which tier includes Belsomra depends on the criteria for the system used by your plan and whether the plan considers the drug a preferred medication.

    How Do I Apply For The Belsomra Patient Assistance Program

    We make it as easy as possible to apply for the Belsomra patient assistance program. The first step is to complete our enrollment application. Tell us about any medications you are taking, including Belsomra. We will also ask for details about your healthcare provider, insurance, and your household income. This information is required by the pharmaceutical manufacturers who ship your medication.

    If we determine that you may be eligible for Belsomra assistance, we will handle the application process for you. We will work directly with your healthcare provider to prepare your application documents. Once we have received the signed application and supporting documents, we will submit them to the patient assistance program on your behalf. Our service continues once you are enrolled in the Belsomra patient assistance program, and we will automatically request your Belsomra medication refills for up to 1 year.

    Read Also: Should I Carry My Medicare Card With Me

    Provider: Merck Patient Assistance Program

    Elligibility requirements:

  • At or below 400% of FPL
  • Must be residing in the US or a US territory, and under the care of a US physician
  • At Merck we realize that sometimes exceptions need to be made based on the patient’s individual circumstances. Individuals who do not meet the insurance criteria may still qualify for the Merck Patient Assistance Program if they attest that they have special circumstances of financial hardship, and their income meets the program criteria. *The Enrollment Form must be mailed. Please do not fax. Call for most recent medications as the list is subject to change.
  • Applicable drugs:

    Requesting Medications Not On Your Patient’s Approved Medication List

    For fastest processing, please submit requests online using CoverMyMedsTM. If all details are submitted online and the request is approved, the member may be able to pick up their prescriptions at the pharmacy in less than 2 hours.

    Other processing methods include:

    • Fax: 800-795-9403
    • Mail: Blue Cross NC, Attn: Corporate Pharmacy, PO Box 2291, Durham, NC 27707

    Once we have all required information, we’ll make a decision within 3 business days and notify you. Requests are processed within 72 hours, unless urgent.

    Urgent requests are handled within 24 hours. An urgent request is when you believe a delay would seriously jeopardize the life or health of the patient, the patient’s ability to regain maximum function, or would subject the patient to severe pain that cannot be adequately managed without the care or treatment requested.

    Also Check: Is Medicare Available For Green Card Holders

    How Much Does Belsomra Cost With Insurance

    Your insurance plan and its coverage can affect your copay for Belsomra. Consult your pharmacist to determine your exact Belsomra cost with insurance. Keep in mind that you can also pay $350.18 for 1, 30 Tablets Tablet with SingleCare. You should compare prices at a pharmacy near you, as many of our users have reported that SingleCare prices are lower than their out-of-pocket costs with insurance.

    Sign Up For Your Free Wellrx Account Today

    Keep your medication information safe & organized.
    • Track, store and manage your medication information

    • Set pill and refill reminders

    • Quickly reprice your medications

    • Import medication data from your pharmacy

    • Set your preferred pharmacy for searches

    Prescription prices may vary from pharmacy to pharmacy and are subject to change. The pricing estimates given are based on the most recent information and may change based on when you actually fill your prescription at the pharmacy.

    < b> DISCOUNT ONLY NOT INSURANCE< /b> . Discounts are available exclusively through participating pharmacies. The range of the discounts will vary depending on the type of prescription and the pharmacy chosen. This program does not make payments directly to pharmacies. Members are required to pay for all prescription purchases. Cannot be used in conjunction with insurance. You may contact customer care anytime with questions or concerns, to cancel your registration, or to obtain further information. This program is administered by Medical Security Card Company, LLC, Tucson, AZ.


    You May Like: How To Qualify For Medicare And Medicaid

    Medications With Limited Or No Plan Coverage

    Some medications may not be covered by the patient’s plan or may have a limited amount the patient can receive. The Table of Drugs with Limited or No Coverage shows a sample listing. Not all limited medications are listed.

    For self-funded and ASO patients, you may need to call Blue Cross NC Customer Service for medication limits that may apply. If you are unsure if your patient’s group is an underwritten or self-funded/ASO group, call the customer service number listed on the back of your patient’s member ID card.

    Does Belsomra Cause Weight Loss Or Weight Gain

    Belsomra shouldnt cause weight loss or weight gain. Weight changes werent reported in people who took the drug in clinical studies.

    A small, 14-week study looked at the use of suvorexant in people with type 2 diabetes and insomnia. This study showed that Belsomra helped improve sleep quality and reduce waist size. But the results didnt show significant weight loss.

    If you have questions about changes in your weight, talk with your doctor. They may recommend ways to reach or maintain a moderate weight.

    Also Check: What Is A Medicare Physical Exam

    What Are The Side Effects Of Belsomra

    Merck reports that roughly 7% of study participants experienced next-day drowsiness after taking Belsomra. Additionally, Belsomra may cause:

    • Abnormal dreams
    • Complex sleep behaviors like eating, walking or driving while asleep
    • Sleep paralysis, a temporary inability to move or talk
    • Temporary weakness of the legs

    Your doctor will determine whether the risks of side effects associated with the drug outweigh its potential benefits.

    What If I Miss A Dose

    If you miss a dose of Belsomra, you should take the missed dose only if you have at least 7 hours before you plan to wake up.

    Taking your dose when you have less than 7 hours to devote to sleep increases your risk of side effects. These include next-day sleepiness and reduced alertness,* which can be dangerous if youll be driving.

    To help make sure that you dont miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone. You can set the reminder to go off when you usually get ready for bed.

    * For more information about this side effect, see the Belsomra side effects section above.

    Recommended Reading: Does Medicare Cover Continuous Glucose Monitoring Systems

    Before Taking This Medicine

    You should not use Belsomra if you are allergic to suvorexant, or if you have narcolepsy.

    To make sure this medicine is safe for you, tell your doctor if you have ever had:

    • depression, mental illness, or thoughts about suicide

    • drug or alcohol abuse or addiction

    • breathing problems, sleep apnea

    • excessive sleepiness during normal waking hours or

    • if you have ever fallen asleep at unexpected times.

    Tell your doctor if you are pregnant or breastfeeding.

    Belsomra is not approved for use by anyone younger than 18 years old.

    Is Nicerx A Belsomra Coupons Provider

    We are a service provider that helps eligible individuals access the Belsomra patient assistance program. That means that we do not offer printable Belsomra manufacturer coupons, Belsomra discounts, or free Belsomra samples. We are not a Belsomra coupon provider or Belsomra discount card. Our service extends to assisting eligible individuals to access the medications they need through patient assistance programs.

    Don’t Miss: Does Medicare Cover Sleep Apnea Studies

    Is There A Generic Of Belsomra

    Belsomra is a brand-name drug. There is no generic version of Belsomra. You can use SingleCare’s prescription discount card to get savings off the retail price of Belsomra until the FDA approves a more affordable generic. CVS, Walmart, Kroger, and Walgreens are just a few of the pharmacies we partner with to save patients money on expensive prescription drugs, like Belsomra.

    How Should I Take Belsomra

    Take Belsomra exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine.

    Belsomra may be habit-forming. Misuse can cause addiction, overdose, or death. Keep the medication in a place where others cannot get to it. Selling or giving away this medicine is against the law.

    Take Belsomra only once per night, 30 minutes before bedtime.

    You may take Belsomra with or without food. Avoid taking the medicine shortly after eating a meal, or the medicine may take longer to work.

    Belsomra will make you fall asleep. Never take this medicine if you do not have 7 hours to sleep before being active again.

    You may have trouble speaking or moving while you are falling asleep. It may take longer for you to wake up, speak, or move around when you wake up. You may feel like you are still dreaming for several minutes after waking.

    Store at room temperature away from moisture, heat, and light. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription.

    Recommended Reading: How To Register For Social Security And Medicare

    People Who Have Both Medicare & Medicaid

    People who have both Medicare and full Medicaid coverage are dually eligible. Medicare pays first when youre a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.

    You can still pick how you want to get your Medicare coverage: Original Medicare or Medicare Advantage . Check your Medicare coverage options.

    If you choose to join a Medicare Advantage Plan, there are special plans for dual eligibles that make it easier for you to get the services you need, include Medicare coverage , and may also cost less, like:

    • Special Needs Plans
    • Medicare-Medicaid Plans
    • Program of All-Inclusive Care for the Elderly plans can help certain people get care outside of a nursing home

    More articles

    Popular Articles