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

Loperamide is a generic over-the-counter anti-diarrheal medication sold as Imodium and other brand names. Most Medicare Part D prescription drug plans do cover it, though some plans may require you to pay a copay or coinsurance. A few plans may not cover it at all, or may list it as a non-preferred drug with a higher cost.

Because loperamide is available without a prescription at pharmacies, you can also buy it out of pocket without using Medicare. Many people do this because the medication is inexpensive — often a few dollars for a box. Whether to use your Part D coverage or pay cash depends on your plan's copay and how many doses you need.

Key Takeaways

  • Loperamide is covered by most Medicare Part D plans, but your specific plan's formulary (drug list) determines whether it is included and what you pay.
  • You can call your Part D plan directly or log into your plan's website to check whether loperamide is on your formulary and what your copay would be.
  • Because loperamide is inexpensive and available over the counter, paying cash is often cheaper than using your Part D coverage.
  • If your plan does not cover loperamide or charges a high copay, you can ask your doctor to request a coverage exception, though approval is not may provide.

How to check your Part D plan's coverage

Your Medicare Part D plan publishes a formulary — a list of drugs the plan covers. To find out whether loperamide is on your plan's formulary, you have three options.

First, call your Part D plan's customer service number, which is on your insurance card. Tell them you want to know whether loperamide is covered and what your copay would be. They can answer in a few minutes.

Second, log into your plan's website using your member ID and password. Most plans have a drug search tool where you type the drug name and see the coverage status and cost when ready.

Third, visit Medicare.gov and use the Plan Finder tool. Enter your zip code, select your plan, and search for loperamide. The tool will show you the formulary status and your out-of-pocket cost for that plan.

When loperamide may not be covered or may cost more

Some Part D plans exclude loperamide entirely, though this is uncommon. More often, a plan may list loperamide as a non-preferred drug, which means your copay is higher than it would be for a preferred alternative. A few plans may require prior authorization — meaning your doctor must request permission from the plan before it will pay.

If your plan does not cover loperamide or charges a copay higher than the retail price, you can buy it over the counter without using your Part D coverage. A standard box of loperamide tablets typically costs $3 to $8 at most pharmacies, which is often less than a Part D copay.

Asking for a coverage exception

If your plan does not cover loperamide or lists it as non-preferred, your doctor can request a formulary exception. This is a formal request asking the plan to cover the drug anyway or to move it to a lower copay tier.

Your doctor will need to explain why loperamide is medically necessary for you — for example, if you have tried other anti-diarrheal drugs and they did not work, or if you have a condition that makes loperamide the best option. The plan will review the request and notify your doctor of the decision, usually within a few days.

Approval is not may provide. Plans deny some exceptions, especially if a preferred alternative exists. If your exception is denied, you can appeal the decision or ask your doctor about other options.

Original Medicare and loperamide

If you have Original Medicare (Part A and Part B) without a Part D plan, loperamide is not covered by Medicare at all. You would need to buy it over the counter out of pocket. Original Medicare does not cover outpatient prescription drugs.

If you are enrolled in a Medicare Advantage plan (Part C) that includes prescription drug coverage, that plan has its own formulary. You would check your Advantage plan's coverage the same way you would check a Part D plan — by calling customer service or using the plan's website.

Generic versus brand-name loperamide

Generic loperamide and brand-name Imodium are the same medication. Most Part D plans cover the generic version and may charge a lower copay for it than for the brand name. If your plan covers both, ask your pharmacist to fill the generic version unless your doctor specifically requests the brand name.

The generic is significantly cheaper at retail as well — often $2 to $4 compared to $6 to $10 for Imodium. If you are paying out of pocket, buying generic loperamide over the counter is usually the most affordable option.

What to do if you cannot afford loperamide

If your Part D copay is high and you cannot afford to pay it, talk to your pharmacist. They can tell you the retail price and help you decide whether to use your insurance or pay cash.

You can also ask your doctor whether there are other anti-diarrheal options covered by your plan at a lower cost. Some plans may cover bismuth subsalicylate (Pepto-Bismol) or other alternatives at a lower copay, though these work differently than loperamide.

If you have a low income, you may be may be able to access for Extra Help, a federal program that lowers Part D copays and premiums. You can learn more about Extra Help by calling 1-800-MEDICARE or visiting Medicare.gov.

Frequently Asked Questions

Can I use my Part D coverage to buy loperamide over the counter at the pharmacy?

Yes. When you buy loperamide at a pharmacy, you can ask the pharmacist to bill your Part D plan instead of paying cash. The pharmacist will process it as a prescription claim, and you will pay your copay. However, compare the copay to the retail price first — paying cash is often cheaper.

Does Medicare cover name-brand Imodium?

Most Part D plans cover brand-name Imodium, but usually with a higher copay than generic loperamide. Check your plan's formulary to see the exact copay for each version. In most cases, generic loperamide is the better value.

What if I switch to a different Part D plan — will the new plan cover loperamide?

Most Part D plans cover loperamide, but not all. When you switch plans during the annual enrollment period, check the new plan's formulary before you enroll to make sure loperamide is covered at a cost you can afford.

Can my doctor write a prescription for loperamide so I can use my Part D coverage?

Yes. Your doctor can write a prescription for loperamide, and you can fill it at a pharmacy and use your Part D coverage. However, since loperamide is available over the counter, many people skip the prescription step and buy it directly. A prescription does not change the medication or make it more effective.

Is loperamide covered if I have a Medicare Advantage plan?

Medicare Advantage plans that include prescription drug coverage have their own formularies. Some cover loperamide and some do not. Check your plan's drug list or call your plan's customer service to find out whether loperamide is covered and what your copay would be.