Medicare Part D covers methyldopa, but your out-of-pocket cost depends on which plan you chose and where the drug sits on your plan's formulary
Methyldopa is a blood pressure medication that Medicare Part D (prescription drug coverage) typically covers. However, "covered" does not mean free. You will pay a copay or coinsurance amount that varies by plan, and some plans may require you to try a different blood pressure drug first before they will pay for methyldopa.
The amount you pay depends on three things: which Part D plan you enrolled in, whether methyldopa is on that plan's formulary (the list of drugs it covers), and what tier it is placed on. A drug on a lower tier costs you less; a drug on a higher tier costs you more. Some plans do not cover methyldopa at all, which means you would pay the full pharmacy price unless you switch plans during the open enrollment period.
Key Takeaways
- Most Medicare Part D plans cover methyldopa, but your copay or coinsurance amount depends on which plan you chose and what tier the drug is on.
- You can find out your exact cost by logging into your plan's website, calling the customer service number on your insurance card, or asking the pharmacist before you fill the prescription.
- If your plan does not cover methyldopa or the cost is too high, you can switch to a different Part D plan during the annual open enrollment period (October 15 to December 7) without penalty.
- Some plans require prior authorization or a step therapy (trying another drug first) before they will cover methyldopa, so confirm this with your plan before your doctor sends the prescription.
How to check if your specific plan covers methyldopa
The fastest way to find your exact cost is to call the customer service number on the back of your Medicare insurance card. Tell them you want to know the copay or coinsurance for methyldopa, and whether the plan requires prior authorization or step therapy. They will give you the answer in minutes.
You can also check online. Log into your plan's website (the login information is in your welcome materials or on your insurance card), go to the drug search tool, and type "methyldopa". The tool will show you the tier, the copay amount, and any restrictions. If you do not have online access or cannot find the tool, call the number on your card and ask them to walk you through it.
A third option is to ask the pharmacist. When your doctor sends the prescription to the pharmacy, the pharmacist can tell you the cost before you pick it up. If the cost surprises you, you can call your plan or your doctor to discuss alternatives before the prescription is filled.
What tier methyldopa is usually on and what that costs
Methyldopa is a generic drug (not a brand name), so most plans place it on a lower tier — usually Tier 1 or Tier 2. Generic drugs cost less than brand-name drugs. On a Tier 1 plan, you might pay $5 to $15 per month. On a Tier 2 plan, you might pay $15 to $30 per month. These are rough ranges; your actual cost depends on your specific plan.
Some plans use coinsurance instead of a copay, which means you pay a percentage of the drug's cost (for example, 20 percent) rather than a flat dollar amount. If your plan uses coinsurance, the pharmacy will tell you the percentage and the actual dollar amount you owe when you fill the prescription.
A few plans may not cover methyldopa at all, or may cover it only after you have tried and failed on another blood pressure medication. This is called step therapy. If your plan has this restriction, your doctor will need to submit a request to the plan explaining why methyldopa is the right choice for you, or you will need to try the other drug first.
Prior authorization and step therapy requirements
Some Medicare Part D plans require prior authorization before the pharmacy will fill methyldopa. This means your doctor's office must contact the plan and get approval before you can pick up the prescription. This usually takes one to three business days, but it can delay your prescription if your doctor's office is slow to submit the request.
Other plans use step therapy, which means the plan will only cover methyldopa after you have tried a different blood pressure drug first and it did not work or caused side effects. If your plan has this rule, your doctor will need to document that you tried the other drug and explain why methyldopa is necessary. This can add weeks to the process, so ask your plan about step therapy requirements before your doctor writes the prescription.
To find out whether your plan has these restrictions, call the customer service number on your insurance card or check the plan's website. Ask specifically: "Does this plan require prior authorization for methyldopa?" and "Does this plan require step therapy for methyldopa?" Write down the answers so you have them when you talk to your doctor.
What to do if your plan does not cover methyldopa or the cost is too high
If methyldopa is not covered or the cost is more than you can afford, you have options. The first is to ask your doctor whether a different blood pressure medication might work for you — one that your plan covers at a lower cost. Your doctor can check your plan's formulary or call the plan directly to find out which blood pressure drugs are covered and at what tier.
The second option is to switch to a different Medicare Part D plan. You can do this during the annual open enrollment period, which runs from October 15 to December 7 each year. During this time, you can switch to any other Part D plan without penalty. You can compare plans on Medicare.gov by entering your zip code and the drugs you take, and the website will show you which plans cover those drugs and what the costs are.
If you need methyldopa before the next open enrollment period, ask the pharmacy whether a generic version is available at a lower price, or ask your doctor whether the plan will cover a different dose or form of the drug at a lower cost. Some plans cover certain strengths or forms but not others.
How Medicare Part D drug tiers work
Medicare Part D plans organize drugs into tiers to help you understand what you will pay. Most plans have four or five tiers. Tier 1 drugs (usually generic) cost the least. Tier 2 drugs (usually brand-name or higher-cost generic) cost more. Tier 3 and Tier 4 drugs cost even more. Some plans also have a specialty tier for very expensive drugs.
Because methyldopa is generic and has been used for decades, it almost always lands on Tier 1 or Tier 2. This means it is one of the cheaper options for blood pressure control on most plans. If your plan places it on a higher tier, that is unusual, and you should call the plan to ask why or to request a review.
Your copay or coinsurance amount for each tier is set by your plan and may change from year to year. Even if you stay in the same plan, your costs might go up in January. This is why it is worth checking your costs every year during open enrollment, even if you are happy with your current plan.
The donut hole and how it affects methyldopa costs
Medicare Part D has a coverage gap called the "donut hole". Once you and your plan have spent a certain amount on drugs in a calendar year (in 2024, that amount is $5,850), you enter the donut hole and your costs go up. You pay a higher percentage of the drug's cost until you reach a second spending threshold (in 2024, that is $7,050 in out-of-pocket costs). After that, you pay a small copay for the rest of the year.
Methyldopa is inexpensive, so it may not push you into the donut hole by itself. However, if you take multiple medications, the combined cost of all your drugs might reach the donut hole threshold. If that happens, your methyldopa copay will increase temporarily until you reach the second threshold. Ask your plan how the donut hole will affect your specific costs.
Frequently Asked Questions
Does Original Medicare (Part A and B) cover methyldopa?
No. Original Medicare covers hospital stays, doctor visits, and some medical equipment, but not prescription drugs. You need Medicare Part D (prescription drug coverage) to have methyldopa covered. Part D is sold by private insurance companies and is separate from Original Medicare.
What if I cannot afford the copay for methyldopa?
Ask your doctor whether a lower-cost blood pressure medication is available that your plan covers at a lower tier. You can also ask the pharmacy whether a generic version or a different strength costs less. Some drug manufacturers offer patient information programs that reduce the cost of their medications for people with low income; your doctor or pharmacist can help you find these programs.
Can I use a GoodRx coupon or discount card instead of my Medicare Part D plan?
You can, but it is usually not allowed. Medicare rules say you cannot use a discount card or coupon if you have Part D coverage — you must use your Part D plan. However, if your plan does not cover methyldopa, you may be able to use a discount card to pay out of pocket. Ask your pharmacist whether this is an option.
Will my methyldopa copay change if I switch Medicare Advantage plans?
Yes. Medicare Advantage plans (Part C) include prescription drug coverage, but each plan has its own formulary and copay amounts. If you switch to a different Medicare Advantage plan, your methyldopa copay may go up or down. Check the formulary of any new plan before you switch to make sure methyldopa is covered and at a cost you can afford.
What happens to my methyldopa coverage if I move to a different state?
Your current Medicare Part D plan may not be available in your new state. You will need to switch to a plan that operates in your new state. You can do this without penalty during the open enrollment period or within 60 days of moving. Check Medicare.gov to see which plans are available in your new zip code and whether they cover methyldopa.