Does Medicare Cover Acetaminophen-Codeine?

Your doctor may prescribe acetaminophen-codeine if you're experiencing mild-to-moderate pain and over-the-counter painkillers don't relieve your symptoms. This medication is relatively affordable, but you may be eligible for Medicare coverage. Below, you can learn which Medicare plans typically cover acetaminophen-codeine and what coverage restrictions and out-of-pocket costs to expect. 

What Is Acetaminophen-Codeine?

Acetaminophen-codeine is a painkiller containing a combination of acetaminophen and codeine. Acetaminophen is commonly used to reduce fever and pain and is available over the counter without codeine.

Codeine is a type of narcotic analgesic that changes the way the brain processes pain. It can cause physical or mental dependence when used long-term. Therefore, your doctor must engage in the Opioid Analgesic Risk Evaluation and Mitigation Strategy program to prescribe this medication.

This drug is available as tablets, solutions and elixirs. It comes in a generic form and under the following brand names:

• APAP wCodeine
• Capital wCodeine
• Pyregesic-C
• Tylenol wCodeine
• Vopac

The most common adult dosage for acetaminophen-codeine is one to two tablets every 4 hours, and your doctor may tell you to limit the total number of tablets you take per day. Taking too much acetaminophen can cause liver damage. Your health care provider will provide a medication guide explaining how to take opioid medications safely.

Acetaminophen-Codeine Side Effects

Acetaminophen-codeine can interact with other medications and may affect your baby if you take it during pregnancy or nursing. Other reported side effects include:

• Itching
• Changes to your breathing rate or shallow breathing
• Pale skin
• Dizziness
• Tiredness
• Fast heartbeat
• Cough
• Hives or skin rash
• Feeling unusually relaxed

Does Medicare Cover Acetaminophen-Codeine?

Generally, Medicare covers acetaminophen-codeine if your plan includes prescription drug benefits. Medicare Parts A and B (Original Medicare) don't cover self-administered medications, so you won't have acetaminophen-codeine coverage unless you purchase a Part D plan (supplemental prescription drug coverage.) All Part D policies cover acetaminophen-codeine.

Alternatively, you could replace your Original Medicare coverage with a Medicare Advantage policy. Medicare Advantage plans must provide the same coverage as Original Medicare Part A and B and don't have to offer prescription drug coverage as standard. However, most of the best Medicare Advantage policies offer this benefit. You can purchase Medicare Advantage or Part D plans from various private insurance companies.

How Much Does Acetaminophen-Codeine Cost With Medicare?

You'll pay for acetaminophen-codeine out of pocket if you have Original Medicare only or until you meet your deductible if your plan includes prescription medication coverage. Acetaminophen-codeine costs around $15 to $27 for 20 300-milligram/30-milligram tablets. 

Once you've spent enough to satisfy your annual deductible, your insurer pays some portion of the costs for all covered prescription medications. Medicare Advantage deductibles vary widely, but you won't pay more than $545 for your Part D deductible (increasing to $505 in 2023.) Some policies include free acetaminophen-codeine coverage, while others charge a $1 co-pay when you fill a prescription.

Acetaminophen-Codeine Coverage Restrictions With Medicare

Many Part D and Medicare Advantage insurers don't require prior authorization from your doctor to approve coverage for acetaminophen-codeine. However, quantity restrictions are common. As acetaminophen-codeine can be habit-forming, most insurers restrict how much medication you can obtain at once.