Medicare Part D covers Dovonex, but only if your plan includes it and you meet your plan's cost-sharing rules

Dovonex (calcipotriene) is a vitamin D-based cream used to treat psoriasis on the skin. Medicare Part D — the prescription drug benefit — does cover Dovonex at many plans, but not all plans cover it the same way. Whether you pay a copay, coinsurance, or a percentage of the cost depends on which Part D plan you're in and where Dovonex sits on that plan's formulary (the list of drugs the plan covers).

The first step is to check your specific plan's formulary. You can do this by logging into your plan's website, calling the customer service number on your insurance card, or using the Medicare Plan Finder tool at Medicare.gov. When you call or search, have your plan name and member ID ready. Ask directly: "Is Dovonex covered, and what is my out-of-pocket cost?"

Key Takeaways

  • Dovonex is a prescription cream covered by most Medicare Part D plans, but coverage and cost vary by plan.
  • You must check your own plan's formulary to learn your exact copay or coinsurance amount.
  • If your plan doesn't cover Dovonex or the cost is too high, you can ask your doctor about generic alternatives or request a coverage exception.
  • Some plans place Dovonex in a higher cost tier; switching plans during open enrollment may lower your out-of-pocket cost.

How to find out what your plan covers

Each Medicare Part D plan publishes its own formulary every year. The formulary lists which drugs are covered and at what tier — Tier 1 (lowest cost) through Tier 5 (highest cost). Dovonex is usually placed in Tier 2 or Tier 3, which means you'll pay a moderate copay or coinsurance.

The fastest way to check is to visit your plan's website and search the formulary by drug name. If you don't have internet access or prefer to speak to someone, call the number on the back of your insurance card. Have your pharmacy's name and phone number ready if the representative asks where you plan to fill the prescription.

If Dovonex is not listed on your plan's formulary, it may still be covered under a different brand name or as a generic. Ask whether calcipotriene (the generic name) is covered instead. If neither is covered, you can request a coverage exception from your plan — your doctor will need to submit a letter explaining why Dovonex is medically necessary for you.

What you'll likely pay out of pocket

If your plan covers Dovonex, your cost depends on which tier it's in. Tier 2 drugs typically have a copay of $10 to $25 per prescription. Tier 3 drugs usually cost $35 to $75 per prescription. Some plans use coinsurance instead of a copay, meaning you pay a percentage (often 20 to 25 percent) of the drug's cost.

Your out-of-pocket costs also count toward your deductible (if your plan has one) and your annual out-of-pocket maximum. Once you reach your maximum, Medicare and your plan cover the full cost of all covered drugs for the rest of the year.

Generic alternatives and lower-cost options

Calcipotriene is available as a generic cream, which is usually cheaper than brand-name Dovonex. Ask your doctor or pharmacist whether the generic version would work for you. Generic calcipotriene is covered by most Part D plans at a lower tier than the brand name.

Other vitamin D-based creams for psoriasis include tacalcitol and maxacalcitol, though these are less commonly used in the United States. Your dermatologist can discuss whether any of these alternatives might be right for your situation and whether they're covered by your plan.

Requesting a coverage exception

If your plan doesn't cover Dovonex or the cost is too high, your doctor can request a coverage exception. This is a formal request asking the plan to cover a drug that isn't on the formulary or to move it to a lower cost tier. Your doctor will need to write a letter explaining the medical reason why Dovonex is necessary for you — for example, if you've tried other treatments and they didn't work.

The plan must respond to the request within 72 hours. If approved, the plan will cover Dovonex at the tier your doctor requested. If denied, you have the right to appeal. Your doctor's office can help you file the appeal or request a peer-to-peer review, where your doctor speaks directly with a plan doctor about your case.

Switching plans if your costs are too high

If you're paying more than you can afford for Dovonex under your current plan, you can switch to a different Part D plan during the Annual Enrollment Period (October 15 to December 7 each year). Use the Medicare Plan Finder tool to compare plans and see which ones cover Dovonex at the lowest cost tier.

When you compare plans, look not just at the copay for Dovonex but also at the plan's deductible, monthly premium, and whether your pharmacy is in the plan's network. A plan with a lower copay for Dovonex might have a higher monthly premium, so calculate your total expected costs for the year.

What to do at the pharmacy

When you fill your Dovonex prescription, tell the pharmacist you have Medicare Part D. The pharmacist will run your insurance and tell you your copay or coinsurance amount. If the cost is higher than you expected, ask the pharmacist to check whether the generic calcipotriene is available and what it would cost.

If you can't afford the copay, ask the pharmacist about the plan's patient information programs or manufacturer coupons. Some drug makers offer copay cards that reduce your out-of-pocket cost. The pharmacist can also contact your doctor to ask whether a different drug on your plan's formulary might work instead.

Frequently Asked Questions

Does Medicare Part B cover Dovonex instead of Part D?

No. Medicare Part B covers injectable and infused drugs given in a doctor's office or hospital. Dovonex is a topical cream you explore at home, so it's covered under Part D (prescription drugs) if your plan includes it. Part B does not cover it.

Will my copay for Dovonex change next year?

Yes, it may. Medicare Part D formularies and copays change every January 1. Your plan may move Dovonex to a different tier, raise the copay, or remove it from the formulary. You'll receive a notice in the fall showing your plan's changes for the coming year.

What if I'm in the coverage gap (donut hole)?

If you reach the coverage gap — the point where you've spent a certain amount on drugs — your copay for Dovonex increases. However, you still receive some coverage. The exact amount you pay depends on your plan. Once you reach your annual out-of-pocket maximum, your plan covers the full cost for the rest of the year.

Can I use a GoodRx coupon instead of my Medicare insurance?

You can, but usually shouldn't. Using a coupon or discount card instead of your insurance means the cost doesn't count toward your deductible or out-of-pocket maximum. In most cases, your Part D copay will be lower than a GoodRx price. Compare both before you decide.

What if my doctor prescribes Dovonex but my plan won't cover it?

Ask your doctor to submit a coverage exception request to your plan. If the plan denies it, your doctor can appeal or request a peer-to-peer review. You can also ask your doctor about other psoriasis treatments your plan does cover, or switch to a different Part D plan during open enrollment.