Medicare does not cover Lofena as a prescription drug benefit
Lofena is a brand-name nonsteroidal anti-inflammatory drug (NSAID) that combines ibuprofen with famotidine, a stomach protectant. Medicare Part D (prescription drug coverage) does not include Lofena on its formulary — the list of drugs each plan covers. This means you would pay the full retail price out of your own pocket if you want this specific medication.
However, the individual ingredients in Lofena are often covered. Generic ibuprofen is available without a prescription and costs very little. Famotidine is also widely covered by Medicare Part D plans. Your doctor may be able to prescribe these drugs separately, which could lower your costs significantly compared to buying Lofena brand-name.
Key Takeaways
- Lofena is not on Medicare Part D formularies, so the drug itself is not covered under prescription drug plans.
- The two ingredients in Lofena — ibuprofen and famotidine — are often covered separately and cost much less.
- You can ask your doctor to prescribe ibuprofen and famotidine as two separate medications instead of the combination product.
- Your specific Medicare Part D plan's formulary determines what drugs are covered, and you can check your plan's list online or by phone.
- If you have already paid for Lofena out of pocket, you may be able to request reimbursement from your plan, though this is uncommon.
Why Lofena is not covered
Medicare Part D plans choose which drugs to cover based on cost, safety, and whether there are cheaper alternatives available. Because ibuprofen and famotidine are both inexpensive and widely available separately, Medicare plans have determined that covering the combination product Lofena is not necessary. Plans prioritize covering drugs that treat conditions where no generic or lower-cost option exists.
Lofena was approved by the FDA in 2013 as a way to reduce stomach upset in people who take NSAIDs regularly. While this combination can be convenient, it is not considered essential when the same protection can be achieved by taking two separate, cheaper drugs.
How to get the same protection for less
Talk to your doctor about taking ibuprofen and famotidine separately instead of Lofena. You can buy ibuprofen over the counter in any pharmacy or grocery store — a bottle of 100 tablets often costs under $5. Famotidine is covered by most Medicare Part D plans and typically costs $5 to $15 per month depending on your plan.
Your doctor can write two separate prescriptions, or you can manage the timing yourself by taking over-the-counter ibuprofen with a dose of famotidine. This approach gives you the same stomach protection as Lofena but at a fraction of the cost. If you have questions about dosing or timing, your pharmacist can walk you through it.
Checking your specific Medicare Part D plan
Every Medicare Part D plan has its own formulary, and Lofena may be handled differently depending on which plan you are in. To find out exactly what your plan covers, log into your plan's website or call the customer service number on your insurance card. You can also use the Medicare Plan Finder tool at Medicare.gov to search for specific drugs and see which plans cover them.
When you call or search, ask whether ibuprofen and famotidine are both covered under your plan, and what your out-of-pocket cost would be for each. This information will help you and your doctor decide whether to use the separate medications or explore other pain relief options.
Other pain relief options covered by Medicare
If ibuprofen and famotidine do not work well for you, Medicare Part D covers many other NSAIDs and pain relievers. Naproxen, meloxicam, and celecoxib are all commonly covered. Acetaminophen (Tylenol) is also available over the counter and is often a good choice for people who cannot take NSAIDs.
If you need stronger pain relief, your doctor can prescribe opioids or other medications that Medicare covers. The key is to talk with your doctor about what you have tried, what side effects you experienced, and what your insurance will cover. Your doctor and pharmacist can work together to find a covered option that works for your situation.
What to do if you already bought Lofena
If you have already purchased Lofena out of pocket, contact your Medicare Part D plan to ask about reimbursement. While most plans do not reimburse for non-covered drugs, some may make exceptions if you can show that you were not aware the drug was not covered. Keep your receipt and the medication bottle in case you need to provide proof of purchase.
Going forward, always check your plan's formulary before filling a prescription for a brand-name drug. This straightforward step can save you money and prevent surprises at the pharmacy counter.
Frequently Asked Questions
Can I ask my doctor to write a prescription for Lofena anyway?
Yes, your doctor can prescribe Lofena, but Medicare will not cover it and you will pay the full retail price. Most retail pharmacies charge $40 to $80 for a month's supply of Lofena. Your doctor may be willing to prescribe the separate ingredients instead, which would be much cheaper.
Is there a generic version of Lofena that Medicare covers?
No. Lofena is a brand-name combination drug and there is no generic equivalent. However, generic ibuprofen and generic famotidine are both available and covered by most Medicare Part D plans.
What if my doctor says I need the combination product specifically?
If your doctor believes the combination is medically necessary for you, ask them to submit a prior authorization request to your Medicare Part D plan. The plan will review the request and may cover Lofena if they agree it is medically necessary. This process usually takes a few days to a week.
Will my costs change if I switch to separate ibuprofen and famotidine?
Almost certainly yes — you will pay less. Over-the-counter ibuprofen costs very little, and famotidine is usually a low-cost covered drug. Together, they cost far less than Lofena would out of pocket, and you may have a small copay or coinsurance depending on your plan.