Medicare's Coverage of Furadantin

Medicare Part D covers Furadantin (nitrofurantoin), a common antibiotic used to treat urinary tract infections, but the amount you pay depends on your specific plan and which tier the drug is on. Most Part D plans include Furadantin on their formulary — the list of covered medications — but you will likely pay a copay or coinsurance when you fill the prescription. The exact cost varies because each plan sets its own formulary and cost-sharing structure.

Whether Medicare covers the cost also depends on whether you have Original Medicare with a separate Part D plan, or Medicare Advantage with drug coverage built in. Both types of coverage typically include Furadantin, but the copay amounts and any prior authorization requirements differ by plan.

Key Takeaways

  • Furadantin is covered by most Medicare Part D plans, but your copay depends on which tier your plan places it on and your plan's specific cost-sharing rules.
  • You can find your plan's exact copay by checking your plan documents, calling the plan's customer service number, or using the Medicare Plan Finder tool on Medicare.gov.
  • Some plans may require prior authorization before the pharmacy can fill your Furadantin prescription, meaning your doctor must get approval first.
  • If your plan's copay is high or the drug is not covered, you can switch to a different Part D plan during the annual open enrollment period in October and November.

How to Find Your Plan's Copay for Furadantin

The fastest way to learn what you will pay is to call the customer service number on the back of your insurance card. Have your prescription ready and ask the representative what your copay or coinsurance is for Furadantin, and whether your doctor needs to request prior authorization before the pharmacy fills it.

You can also check your plan's formulary online. Most Medicare plans post their formularies on their websites, organized by drug name. Search for "nitrofurantoin" or "Furadantin" and the document will show the tier and any restrictions. If you do not have internet access or cannot find the formulary, call your plan and ask them to mail you a printed copy or read the information to you over the phone.

The Medicare Plan Finder tool on Medicare.gov also shows drug coverage for plans in your area. You can enter Furadantin and see which plans cover it and at what cost, though the tool works best during the annual open enrollment period in October and November.

What Happens if Your Plan Does Not Cover Furadantin

If your current Part D plan does not cover Furadantin or charges a very high copay, you have options. During the annual open enrollment period from October 15 through December 7 each year, you can switch to a different Part D plan that does cover the drug at a lower cost. You can also switch if you have a may have access to life event, such as moving to a new state or losing other insurance coverage.

If you need Furadantin before the next open enrollment period, talk to your doctor about whether a different antibiotic on your plan's formulary would work for your infection. Some urinary tract infection antibiotics are covered at lower costs on most plans. Your doctor can also request a coverage exception from your plan, asking them to cover Furadantin even if it is not on the formulary or to waive a prior authorization requirement.

Prior Authorization and Other Restrictions

Some Medicare Part D plans require prior authorization for Furadantin, meaning your doctor must contact the plan and get approval before the pharmacy can fill the prescription. This usually takes one to two business days. If your plan has this requirement, your doctor's office will handle the request — you do not need to do anything except wait for confirmation that the prescription is approved.

A few plans may also have quantity limits, meaning they will only cover a certain number of pills per month or per prescription. If your doctor prescribes more than the limit, you will either need to pay out of pocket for the extra pills or your doctor can request an exception from the plan.

Cost-Sharing During Different Parts of the Year

Your copay for Furadantin may change depending on where you are in the Medicare Part D benefit year, which runs from January 1 through December 31. Early in the year, you pay your regular copay. Once you and your plan have spent a certain amount on your medications combined — called the initial coverage limit — you enter the coverage gap, sometimes called the "donut hole." In the gap, you pay a higher percentage of the drug cost, though this amount is capped.

Once your out-of-pocket costs reach a certain threshold, you move into catastrophic coverage, where Medicare pays most of the cost and you pay only a small copay. For 2024, these thresholds change yearly, so ask your plan what they are for your coverage year. Since Furadantin is an inexpensive antibiotic, you may never reach the coverage gap for a single prescription, but it is worth understanding how your plan works if you take multiple medications.

What to Ask Your Doctor and Pharmacist

When your doctor prescribes Furadantin, ask whether it is covered by your Medicare plan and what your copay will be. If your doctor does not know, they can call your plan or ask their office staff to check. You can also ask your pharmacist to check coverage before you fill the prescription — many pharmacies can look this up in seconds.

If the copay is higher than you expected, ask your doctor whether a generic version is available (nitrofurantoin is the generic form of Furadantin, and generics are usually cheaper) or whether an alternative antibiotic might work and cost less on your plan.

Frequently Asked Questions

Does Original Medicare Part A and B cover Furadantin?

No. Original Medicare Part A and Part B do not cover prescription drugs. You need a separate Part D plan or a Medicare Advantage plan with drug coverage to have Furadantin covered. If you have Original Medicare without Part D, you will pay the full cost of the prescription out of pocket.

What is the difference between Furadantin and nitrofurantoin?

Furadantin is the brand name; nitrofurantoin is the generic medication. They are the same drug. Generic versions are usually cheaper, and most Medicare plans cover both. Ask your pharmacist whether the generic is available and what your copay would be.

Can I use a GoodRx coupon or discount card instead of my Medicare coverage?

You can, but it is usually not allowed to use both at the same time. If your Medicare copay is higher than the GoodRx price, you may be able to use the discount card instead, but this does not count toward your Part D deductible or out-of-pocket maximum. Talk to your pharmacist about which option costs less for your specific prescription.

What if I cannot afford the copay for Furadantin?

Contact your plan's customer service and ask whether they have a patient information program or hardship fund. Some plans offer reduced copays for people with financial hardship. You can also ask your doctor's office whether the drug manufacturer offers a copay information program for uninsured or underinsured patients.

Will my copay change if I switch pharmacies?

No. Your copay is set by your Medicare plan, not by the pharmacy. However, some pharmacies may offer their own discounts or loyalty programs that could lower your cost further. It is worth asking your pharmacist whether they have any programs available.