Medicare covers levothyroxine, but your out-of-pocket cost depends on which Medicare plan you have and which pharmacy you use

Levothyroxine is a generic medication that replaces thyroid hormone in your body. Medicare Part B does not cover it — instead, you need either Medicare Part D (prescription drug coverage) or a Medicare Advantage plan that includes drug benefits. Most people with Medicare can get levothyroxine covered, but the amount you pay at the pharmacy varies widely based on your plan's formulary (the list of drugs it covers) and your pharmacy's contract price.

The good news is that levothyroxine is inexpensive compared to many other medications. Because it is a generic drug available from multiple manufacturers, the price at the pharmacy counter is often low enough that some people pay less than their copay would be. However, you still need to know which plan covers it and at what tier, because that determines whether you pay a flat copay or a percentage of the cost.

Key Takeaways

  • Levothyroxine is covered by most Medicare Part D plans and Medicare Advantage plans with drug benefits, but you must check your specific plan's formulary to confirm.
  • The drug is usually placed on Tier 1 or Tier 2 (the lowest cost tiers), so your copay is typically between $0 and $15 per month.
  • Generic levothyroxine costs less than brand-name Synthroid, and Medicare plans almost always prefer the generic version.
  • Your pharmacy's contract price affects what you pay, so calling ahead to compare prices at different pharmacies can save you money even within the same plan.
  • If your plan does not cover levothyroxine or places it on a high tier, you can request a formulary exception from your plan or switch plans during the annual enrollment period.

How Medicare Part D covers levothyroxine

Medicare Part D is the prescription drug benefit you add to Original Medicare (Part A and Part B). If you have Original Medicare and take levothyroxine, you must be enrolled in a Part D plan to have the drug covered. Part D is offered by private insurance companies under contract with Medicare, so each plan has its own formulary and pricing.

Levothyroxine appears on the formulary of nearly all Part D plans because it is a low-cost generic drug that millions of seniors take. Most plans place it on Tier 1 or Tier 2, which means your copay is the lowest or second-lowest amount the plan charges. In 2024, Tier 1 copays typically range from $0 to $5, and Tier 2 copays from $5 to $15, though your specific plan may differ.

To find out your exact copay, log into your plan's website or call the customer service number on your insurance card. You can also ask your pharmacist to look it up when you fill the prescription. If your plan does not list levothyroxine on its formulary, or if it is on a higher tier, you have options — see the section below on what to do if your plan does not cover it.

Levothyroxine coverage under Medicare Advantage plans

Medicare Advantage (Part C) plans are an alternative to Original Medicare. Most Medicare Advantage plans include prescription drug coverage built in, so you do not need to buy Part D separately. These plans also cover levothyroxine on their formularies in most cases, usually at a low copay.

Medicare Advantage plans are run by private insurers and vary by region, so the copay you pay depends on which plan you have and which pharmacy you use. Some plans offer $0 copays for generic drugs on Tier 1, while others charge $5 or $10. Call your plan or check its website to see where levothyroxine sits on your formulary.

If you are thinking about switching to a Medicare Advantage plan, check whether levothyroxine is covered before you enroll. Plans change their formularies each year, so if you already have Medicare Advantage, review your coverage during the annual enrollment period (October 15 to December 7) to make sure your drug remains covered at an affordable tier.

What to do if your plan does not cover levothyroxine or charges too much

If your Part D or Medicare Advantage plan does not cover levothyroxine, or if it is on a tier with a high copay, you have three main options. The first is to request a formulary exception from your plan. This is a formal request asking the plan to cover the drug or move it to a lower tier. Your doctor must submit the request, usually stating that you have tried other drugs or that levothyroxine is medically necessary for you. Plans must respond within 72 hours for urgent requests and 7 calendar days for standard requests.

The second option is to pay out of pocket. Because levothyroxine is generic and inexpensive, the cash price at many pharmacies is $10 to $30 per month — sometimes less than your copay would be. Ask your pharmacist for the cash price before you use your insurance. You can also use a discount program like GoodRx to compare prices across pharmacies.

The third option is to switch plans during the annual enrollment period. If your current plan does not cover levothyroxine well, you can choose a different Part D plan or Medicare Advantage plan that does. You have until December 7 each year to make changes that take effect January 1. If you have a life-changing event (such as moving to a new state or losing other insurance), you may be able to switch outside the annual period.

Generic levothyroxine versus brand-name Synthroid

Medicare plans almost always cover generic levothyroxine at a lower copay than brand-name Synthroid. Generic levothyroxine is chemically identical to Synthroid and works the same way in your body. The main difference is price: generic levothyroxine costs a fraction of what Synthroid does, so your copay is much lower.

If your doctor prescribed Synthroid by brand name, ask whether you can switch to generic levothyroxine instead. Most people can make this switch without any problem. If your doctor believes you need the brand-name version for a specific medical reason, they can request a formulary exception to have it covered, but this is uncommon for thyroid medication.

Pharmacy prices and how to find the lowest cost

Even within the same Medicare plan, the price you pay for levothyroxine can differ between pharmacies. This is because each pharmacy negotiates its own contract price with your insurance plan. A pharmacy that fills many prescriptions may have a lower contract price than one that fills fewer, and that savings can be passed to you.

Before you fill your prescription, call two or three pharmacies in your area and ask what your copay would be for levothyroxine at each one. You can also use your plan's pharmacy finder tool on its website to see which pharmacies are in network and what their prices are. Some plans offer mail-order pharmacy options that may be cheaper for a 90-day supply than picking up at a local pharmacy.

If you use a discount program like GoodRx or SingleCare, compare that price to your insurance copay. Sometimes paying cash with a discount code is cheaper than using your insurance, especially if your plan's copay is high or if you have not yet met your deductible.

What to ask your doctor and pharmacist

Before you fill a levothyroxine prescription, ask your doctor and pharmacist these questions to make sure you understand your coverage and cost:

  • Is levothyroxine covered by my Medicare plan, and what is my copay?
  • Should I use generic levothyroxine or brand-name Synthroid, and why?
  • Which pharmacy in my plan's network has the lowest price for this drug?
  • If my plan does not cover it, can you request a formulary exception?
  • Is there a 90-day supply option that costs less than three 30-day fills?

Frequently Asked Questions

Does Medicare Part B cover levothyroxine?

No. Medicare Part B covers doctor visits and some medical services, but not prescription drugs. You need Medicare Part D or a Medicare Advantage plan with drug coverage to have levothyroxine covered. If you have Original Medicare and no drug plan, you pay the full pharmacy price out of pocket.

What if I cannot afford my copay for levothyroxine?

Ask your pharmacist for the cash price — it is often $10 to $30 per month, which may be less than your copay. You can also use a discount program like GoodRx or ask your doctor whether a patient information program from the drug manufacturer offers free or low-cost levothyroxine. Some community health centers also provide medications at reduced cost based on income.

Can I get a 90-day supply of levothyroxine to save money?

Yes. Many Medicare plans offer a lower copay for a 90-day supply than for three separate 30-day fills. Ask your pharmacist or your plan whether this option is available and how much you would save. Mail-order pharmacies often offer 90-day supplies at a discount.

What happens to my levothyroxine coverage if I switch Medicare plans?

Coverage depends on your new plan's formulary. Before you switch, check the new plan's website or call its customer service to confirm that levothyroxine is covered and at what copay. If you switch during the annual enrollment period, your new coverage starts January 1. If you switch outside the annual period due to a life-changing event, your new coverage starts on the first of the month after your request is approved.

Is there a brand-name levothyroxine that Medicare covers better than generic?

No. Medicare plans cover generic levothyroxine at the lowest copay tier. Brand-name Synthroid is more expensive and usually requires a higher copay or a formulary exception. Stick with generic levothyroxine unless your doctor has a specific medical reason to prescribe the brand name.