Medicare's coverage of Noritate depends on which part of your plan you have and where you fill the prescription
Noritate is a topical antibiotic cream used to treat rosacea, a skin condition that causes redness and small bumps on the face. Medicare Part D (prescription drug coverage) covers Noritate at most pharmacies, but the amount you pay out of pocket depends on your specific plan and which tier the medication sits on. Medicare Part B does not cover Noritate because it is a prescription medication you take at home, not a service or supply administered in a medical setting.
Whether your plan covers Noritate at all, and how much of the cost falls to you, varies by insurance company and by year. Some plans place Noritate on a higher tier, meaning you pay more. Others may require you to try a different medication first before they will cover it — this is called a prior authorization. The only way to know what your plan covers is to check your coverage documents or call the customer service number on your insurance card.
Key Takeaways
- Noritate is covered by Medicare Part D at most pharmacies, but your out-of-pocket cost depends on your individual plan's drug formulary and tier placement.
- Your plan may require prior authorization, meaning your doctor must get approval from your insurance company before the pharmacy will fill the prescription.
- You can find your plan's coverage details by calling the number on your Medicare card, checking your plan's website, or asking your pharmacist.
- If your plan does not cover Noritate or the cost is too high, your doctor may suggest a generic alternative or a different rosacea treatment that your plan does cover.
How to check if your plan covers Noritate
The fastest way to find out is to call the customer service number on the back of your Medicare card. Have your plan name and member ID ready. Tell them you want to know if Noritate is covered under your Part D plan, what tier it is on, and whether your doctor needs to request prior authorization before you fill it.
You can also log into your plan's website and search the drug formulary — a list of all medications your plan covers. Most insurance companies let you search by drug name and see the tier, any restrictions, and the copay amount. If you do not have online access, call and ask the representative to read you this information over the phone.
Another option is to ask your pharmacist. When you bring a Noritate prescription to the counter, the pharmacist can look up your coverage in real time and tell you whether it will be covered and what you will owe. This is often the fastest way to get an answer if you are standing at the pharmacy.
What prior authorization means and why your plan might require it
Prior authorization is a requirement from your insurance company that your doctor must get approval before the pharmacy fills your prescription. It does not mean your plan will not cover the medication — it means the plan wants your doctor to confirm that Noritate is medically necessary for you and that you have not already tried other treatments.
Some Medicare Part D plans require prior authorization for Noritate because there are other topical antibiotics available for rosacea, and the plan wants to control costs by encouraging the use of less expensive options first. If your plan requires it, your doctor's office will submit the request to your insurance company, usually by phone or online form. Approval typically takes one to three business days, though it can sometimes happen the same day.
If your doctor's office is slow to submit the request, call them and ask for a status update. You can also call your insurance company directly and ask whether the request has been received. Do not wait passively — a phone call often speeds things up.
Understanding your out-of-pocket costs
Medicare Part D plans organize drugs into tiers, usually ranging from tier 1 (lowest cost) to tier 5 (highest cost). Noritate is typically placed on tier 2 or tier 3, meaning you will pay a moderate copay — often between $15 and $50 per prescription, depending on your plan. Some plans use coinsurance instead, meaning you pay a percentage of the drug's cost rather than a flat copay.
Your costs also depend on where you are in the coverage year. Early in the year, you pay your regular copay. Once you have spent a certain amount out of pocket (called the deductible), your costs may change. Later in the year, if your total drug spending reaches a higher threshold, you may enter the "donut hole" — a coverage gap where you pay more. The exact amounts change each year, so check your plan documents for the current year's numbers.
If the copay is more than you can afford, ask your doctor whether a generic version is available or whether another rosacea treatment might work and cost less under your plan. You can also look into whether you may have access to for a low-income subsidy, which can reduce your Part D costs significantly.
Generic alternatives and other rosacea treatments
Noritate contains the active ingredient metronidazole. A generic version of metronidazole cream is available and is usually cheaper than brand-name Noritate. If your plan covers the generic but not the brand name, or if the generic has a lower copay, ask your doctor to prescribe the generic instead. The medication works the same way.
If your plan does not cover Noritate or the cost is too high even with generic options, other treatments for rosacea may be covered at a lower cost. These include oral antibiotics like doxycycline, sulfur-based topical treatments, or azelaic acid. Your dermatologist or primary care doctor can discuss which alternatives might work for your specific case and check coverage under your plan before prescribing.
What to do if your plan denies coverage
If your insurance company denies coverage for Noritate, you have the right to appeal the decision. Your doctor can submit an appeal on your behalf, usually with a letter explaining why Noritate is medically necessary for you — for example, if you have already tried other treatments and they did not work. Appeals often succeed, especially if your doctor provides clinical justification.
You can also ask your doctor to request a coverage exception, which is a formal request to your insurance company to cover a drug that is not normally on the formulary or to waive a prior authorization requirement. The process takes a few days to a week, but it is worth pursuing if Noritate is the right medication for you.
If the appeal is denied and you cannot afford the medication, talk to your doctor about payment information programs run by the drug manufacturer. Noritate's maker may offer copay cards or patient information programs that reduce or cover the cost for people who meet income requirements.
Frequently Asked Questions
Does Medicare Part B cover Noritate?
No. Medicare Part B covers services and supplies administered in a medical office or hospital, not prescription medications you use at home. Noritate is covered only under Medicare Part D, which is prescription drug coverage.
Will I pay the same copay for Noritate every time I fill it?
Usually, yes — your copay stays the same throughout the year unless you reach the coverage gap (donut hole). Once you hit that threshold, your costs increase. Check your plan documents to see when the donut hole begins for your plan in the current year.
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 a discount card price is lower than your Medicare copay, you may choose to pay out of pocket with the discount card instead. Tell the pharmacist you want to use the discount card, not your Medicare coverage. Be aware that using a discount card does not count toward your Part D deductible or out-of-pocket maximum.
What if I cannot afford my Noritate copay?
Ask your doctor about generic metronidazole cream, which usually costs less. You can also ask about other rosacea treatments your plan covers at a lower cost. If cost remains a barrier, ask whether you may have access to for a low-income subsidy through Medicare, or contact the drug manufacturer about patient information programs.
How long does prior authorization take?
Most prior authorization requests are approved within one to three business days. Some are approved the same day. If your doctor's office submits the request and you do not hear back within three days, call and ask for a status update. Do not wait for the pharmacy to follow up — calling your doctor's office directly usually speeds the process.