Will Medicare Part D Plans Cover the Cost of Claritin?

Claritin belongs to a class of drugs known as antihistamines which are used to treat symptoms associated with allergies, including sneezing, watery eyes, runny nose, and hives, according to the National Institute of Health (NIH). It is available over the counter without a prescription and like other over-the-counter (OTC) medications, is usually not eligible for Medicare coverage.

What is Claritin

Claritin is the brand name for the generic drug loratadine, according to NIH. When your body encounters something that triggers an allergic reaction such as pollen, animal dander, or dust mites, it releases chemicals known as histamines. Histamines cause allergic symptoms, according to NIH. Antihistamines work to counteract allergic symptoms by blocking the action of histamines in the body says the NIH. Claritin comes as a syrup, an immediate acting and extended release tablet, and a rapidly dissolving tablet all to take by mouth.

Is there Medicare coverage for Claritin?

Original Medicare (Part A and Part B) only covers prescription drugs in very specific circumstances; most Medicare coverage for prescription drugs is only available through a stand-alone Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug plan. However, most Medicare Prescription Drug Plans do not typically cover several classes of medications, including:

• Over-the-counter medications available without a prescription (including Claritin)
• Cough, cold, and flu remedies
• Most vitamin and mineral supplements
• Medications for weight loss or weight gain
• Remedies for cosmetic purposes or hair growth
• Fertility drugs
• Drugs for erectile dysfunction

What Medicare coverage is available with Part D Prescription Drug Plans?

Most stand-alone Medicare Part D and Medicare Advantage Prescription Drug plans cover prescription drugs your doctor believes are medically necessary to treat your condition, as long as they are contained on the plan’s formulary, which is a list of prescription medications approved for Medicare coverage under the plan’s guidelines. When you visit your health-care provider, be sure to let him or her know if you are enrolled in a Medicare Prescription Drug plan so he or she can choose medications on your plan’s formulary whenever possible. This will help keep your out-of-pocket costs lower. Some Medicare Advantage plans also offer additional benefits, such as discounts on certain over-the-counter medications; consult your plan guidelines for details.

Many Medicare Prescription Drug Plans use a tiered formulary system; drugs in lower tiers typically have a smaller copayment than drugs in higher tiers. Keep in mind that plan formularies may change at any time, but your plan must give you written notice before any changes go into effect. If a medication you currently take is removed from your plan formulary at any time, you may take your written notice to the pharmacy and get a 60-day supply of your medication under the existing plan rules.

If you need help finding a plan that meets your Medicare health-care needs, I’m available to work with you and answer your questions. You can schedule a telephone call or request an email with plan information prepared just for you by clicking the appropriate link