What Medicare covers for inhalers
Medicare Part D (prescription drug coverage) covers most inhalers, including rescue inhalers like albuterol and maintenance inhalers like fluticasone. The Astra brand name does not appear in current Medicare formularies — what Medicare actually covers is the active ingredient inside the inhaler, not the brand name on the box.
If your doctor prescribed an Astra inhaler specifically, Medicare will cover the generic equivalent or a different brand with the same active ingredient. Your out-of-pocket cost depends on which Part D plan you chose and where that drug sits on your plan's formulary (the list of covered medications ranked by tier).
Medicare Part B does not cover inhalers at all — Part B pays for hospital stays, doctor visits, and medical equipment like oxygen tanks, but not prescription drugs you pick up at a pharmacy. You must have Part D or another prescription drug plan to get inhaler coverage.
Key Takeaways
- Medicare Part D covers the active ingredients in inhalers, not brand names, so an Astra inhaler would be covered as its generic equivalent or a formulary alternative.
- Your out-of-pocket cost for an inhaler ranges from a copay (usually $5 to $50 per fill) to coinsurance, depending on which Part D plan you have and the drug's tier.
- You must have Part D or another prescription drug plan — Part B does not cover inhalers.
- If your plan does not cover the exact inhaler your doctor prescribed, you can ask your doctor to request a formulary exception or switch to a covered alternative.
How to check if your specific inhaler is covered
Log into your Part D plan's website or call the customer service number on your insurance card. Tell them the name of the inhaler and the strength your doctor prescribed. They will tell you the tier (how much you pay), whether you need prior authorization, and whether a generic or different brand is available at a lower cost.
If you do not have your plan information handy, call Medicare directly at 1-800-MEDICARE (1-800-633-4227). They can tell you which Part D plans cover your inhaler in your area and what the costs are for each plan. This is useful if you are comparing plans during the annual enrollment period (October 15 to December 7 each year).
Bring this information to your pharmacy when you fill the prescription. The pharmacist can also tell you the cost and whether your plan requires prior authorization — a step where your doctor's office confirms the medication is medically necessary before the plan will pay.
What happens if your plan does not cover your inhaler
If your Part D plan does not cover the inhaler your doctor prescribed, you have three options. First, ask your doctor whether a covered alternative with the same active ingredient would work for you — for example, if your plan does not cover one brand of albuterol, it likely covers another.
Second, request a formulary exception. Your doctor's office submits a form to your insurance plan explaining why this specific inhaler is medically necessary for you. The plan usually responds within 72 hours. If approved, the plan will cover it, though you may still pay a higher copay than for a preferred drug.
Third, pay out of pocket. Rescue inhalers (albuterol, levalbuterol) usually cost $30 to $60 per inhaler without insurance. Maintenance inhalers (fluticasone, budesonide, mometasone) range from $50 to $200 depending on the type and strength. Some manufacturers offer discount cards that reduce the price if you do not use insurance.
Prior authorization and step therapy
Some Part D plans require prior authorization before they will pay for certain inhalers, especially maintenance inhalers. This means your doctor's office must contact the insurance plan first and get approval. The process usually takes one to three business days, but it can delay your prescription if your doctor's office is slow to submit the form.
A few plans use step therapy, which means you must try a cheaper drug first before the plan will cover a more expensive one. For example, the plan might require you to try a generic albuterol inhaler before covering a brand-name rescue inhaler. If the first drug does not work for you, your doctor can request an exception and move to the next option.
Ask your pharmacist whether your prescription needs prior authorization before you leave the pharmacy. If it does, they can contact your doctor's office right away rather than waiting for you to call later.
Costs at different stages of the year
Your out-of-pocket cost for an inhaler changes depending on where you are in the calendar year. From January through your deductible, you pay the full price of the drug. Once you meet your deductible (usually $505 to $560 in 2024, though this varies by plan), you enter the copay stage and pay a fixed amount per fill — typically $5 to $50 for a rescue inhaler and $10 to $75 for a maintenance inhaler.
If you reach the coverage gap (also called the "donut hole"), you pay 25 percent of the drug cost until your total out-of-pocket spending hits the catastrophic threshold. After that, Medicare pays most of the cost and you pay a small copay. The exact amounts change each year, so check your plan's summary of benefits for current figures.
If you use your inhaler regularly, you may hit the coverage gap by mid-year. Ask your doctor whether a 90-day supply would lower your per-dose cost, or whether switching to a generic version would reduce your total spending.
Switching plans if your inhaler is not covered
If your current Part D plan does not cover your inhaler at a cost you can afford, you can switch to a different plan during the annual enrollment period (October 15 to December 7). Use the Medicare Plan Finder tool at Medicare.gov to compare plans in your area and see which ones cover your specific inhaler and at what cost.
You can also switch if you have a may have access to life event — moving to a new state, losing other insurance, or a change in income. Call 1-800-MEDICARE to report the event and ask whether you can switch plans outside the enrollment period.
If you switch plans, your new coverage starts January 1 of the following year (or the first of the month after you report a may have access to event). Plan ahead so you do not run out of your current inhaler before the switch takes effect.
Frequently Asked Questions
Do I need prior authorization to fill a rescue inhaler?
Most plans do not require prior authorization for rescue inhalers like albuterol, but some do. Call your plan or ask your pharmacist before your doctor writes the prescription. If authorization is needed, your doctor's office can usually get it approved within one business day.
What if I cannot afford the copay for my inhaler?
Ask your doctor whether a generic version or different brand is available at a lower tier. Some manufacturers offer copay information cards that reduce your cost to $0 or $5 per fill if you meet income requirements. Your pharmacist or doctor's office can help you find these programs.
Does Medicare cover inhalers if I have both Part A and Part B but no Part D?
No. Part A and Part B do not cover prescription drugs. You must have Part D or another prescription drug plan (like coverage from a former employer or the Veterans Administration) to get inhaler coverage. You can join a Part D plan during the annual enrollment period or within 63 days of losing other drug coverage.
Can I use a GoodRx coupon instead of my Medicare insurance for an inhaler?
You can, but it usually costs more. Compare the GoodRx price to your Part D copay before you decide. If your Part D copay is lower, use your insurance. If GoodRx is cheaper and you have not met your deductible yet, GoodRx may be the better choice — but using GoodRx does not count toward your deductible or out-of-pocket maximum.
What if my doctor prescribed a brand-name inhaler but my plan only covers generic?
Ask your doctor to write "generic substitution allowed" on the prescription, or call your pharmacy and ask them to fill it with the generic version. If your doctor believes the brand name is medically necessary, they can request a formulary exception. Most plans respond within 72 hours.