Does Medicare Cover Pletal?

Problems with blood circulation can cause a range of problems, including pain and numbness. For some people, the prescription drug Pletal can help alleviate symptoms. If your doctor has mentioned Pletal as a possible solution, it's helpful to understand if your health insurance will help you keep costs under control. 

Original Medicare Part A and Part B don't cover Pletal, but all Medicare prescription drug plans do; this includes most Medicare Advantage plans. Keep in mind that the final cost depends on your pharmacy and location as well as your plan's current benefit phase.

What Is Pletal Used For?

Pletal, which is a brand-name version of cilostazol, is prescribed to help with claudication — pain or discomfort in your legs that happens when you walk. In some people, claudication can also occur in the arms.

Pletal belongs to the platelet-aggregation inhibitor family. It helps stop clots from forming in your blood; at the same time, it helps your vessels to relax. These two factors help increase blood flow. Since claudication is caused by restricted blood flow due to narrow vessels, Pletal can resolve the symptoms.

For many people, it can take more than a month to experience the full effects of Pletal; it's important to follow your doctor's instructions closely. This type of medication isn't usually safe for people with congestive heart failure.

Pletal Costs With Medicare Coverage

While all Medicare Part D plans and many Medicare Advantage plans cover Pletal, the costs can vary considerably. Before you meet your plan's deductible, you'll need to pay for the medication upfront. It's worth your time to compare prices at multiple local pharmacies; you may be able to save money by choosing a different store.

Deductibles are set by the provider, but by law, they can't be more than $545 in 2024. When you meet the deductible for your prescription drug plan, coverage starts. From then until the end of the year, you can get Pletal with just a co-pay or coinsurance payment. That amount depends on where Pletal falls in your plan's tier system. Many providers classify it as a Tier 2 drug, which means it's on the more affordable end of the spectrum. 

Medicare Coverage Restrictions for Pletal

Medicare Part D and Medicare Advantage plans may have a prior authorization restriction for Pletal. That means that your doctor must get approval from the plan before you can get coverage. In addition, your plan might set quantity limits that restrict how many pills you can buy at one time.