Medicare Part D covers trandolapril, but your out-of-pocket cost depends on which plan you have and which pharmacy you use

Trandolapril is an ACE inhibitor — a blood pressure medication that works by relaxing blood vessels. Medicare Part D (prescription drug coverage) covers trandolapril, but whether it appears on your plan's formulary (the list of covered drugs) and what you pay for it varies by plan and pharmacy. Some plans cover it with no restrictions; others require you to try a different blood pressure medication first or charge a higher copay. The generic version is almost always cheaper than the brand name Mavik.

Your actual cost depends on three things: which Part D plan you chose, which pharmacy you use, and whether you are in the coverage gap (donut hole). If you have Original Medicare without Part D, you would pay the full price out of pocket unless you have a separate prescription drug plan or coverage from another source.

Key Takeaways

  • Trandolapril is covered under Medicare Part D, but the copay and whether it requires prior approval depends on your specific plan.
  • The generic version of trandolapril costs less than the brand name Mavik and is covered by most Part D plans.
  • You can check your plan's formulary and compare pharmacy prices on Medicare.gov or by calling your plan directly.
  • If your plan does not cover trandolapril or the copay is too high, you can switch plans during the annual open enrollment period or ask your doctor about alternative blood pressure medications your plan does cover.

How to check if your Part D plan covers trandolapril

Start by looking at your plan's formulary, which lists every drug your plan covers. You can find this on your plan's website or by calling the customer service number on your insurance card. When you call, have your plan name and member ID ready, and ask specifically whether trandolapril is on the formulary and what your copay would be at your preferred pharmacy.

You can also search Medicare.gov's Plan Finder tool. Enter your zip code, select your plan, and search for "trandolapril" to see the copay amount and any restrictions. If you do not have a plan yet or are comparing options, the Plan Finder shows you what each plan in your area covers and costs for this drug.

Prices vary by pharmacy, so call ahead or use your plan's pharmacy locator to compare. A copay at CVS might differ from one at Walgreens or an independent pharmacy. Some mail-order pharmacies through your plan offer lower copays for 90-day supplies.

What restrictions might explore to your coverage

Some Part D plans place trandolapril in a higher cost tier, meaning you pay more than you would for a generic blood pressure medication in a lower tier. Others may require prior authorization — your doctor must contact the plan and explain why you need this specific drug before the plan will cover it. This usually happens when the plan wants you to try a cheaper alternative first.

A few plans may require step therapy, which means you must try and fail on another blood pressure medication before the plan will cover trandolapril. If your plan has this restriction and you have been on trandolapril for a while, your doctor can often request an exception.

If your plan does not cover trandolapril at all, ask your doctor whether a similar ACE inhibitor on your plan's formulary — such as lisinopril or enalapril — would work for you. These are usually cheaper and more widely covered.

The coverage gap and how it affects your cost

Once you and your plan have paid a combined total of $5,850 in 2024 (this amount changes yearly), you enter the coverage gap, sometimes called the donut hole. In the gap, you pay a higher percentage of the drug cost until you reach catastrophic coverage. For most drugs, including trandolapril, you pay 25 percent of the cost in the gap.

If you take trandolapril regularly, you may hit the coverage gap by late fall. When you do, your copay jumps. For example, if your copay was $10 per month, you might pay $20 or more per month in the gap. Once your out-of-pocket costs reach $7,050 in 2024, catastrophic coverage kicks in and you pay only a small copay again for the rest of the year.

If you are on a limited income, you may be able to get help paying for drugs in the coverage gap through the Extra Help program (also called Low-Income Subsidy). Contact your local Social Security office or call 1-800-772-1213 to see whether you may have access to.

Generic versus brand-name trandolapril

The generic version of trandolapril costs significantly less than the brand name Mavik. Most Part D plans cover the generic at a lower copay — often $5 to $15 per month — while the brand name might cost $30 or more. Unless your doctor has a specific reason you need the brand name, ask for the generic.

Generic trandolapril contains the same active ingredient and works the same way as Mavik. The FDA requires generic drugs to meet the same quality and safety standards as brand-name drugs. If you have been taking Mavik and your plan switches you to generic, the medication will work the same way.

What to do if your plan does not cover trandolapril or the cost is too high

If your current plan does not cover trandolapril or the copay is unaffordable, you have options. During the annual open enrollment period (October 15 to December 7 each year), you can switch to a different Part D plan that does cover it at a lower cost. Use the Plan Finder tool to compare plans in your area and see which ones cover trandolapril with the lowest copay.

If you cannot wait until open enrollment and you have a may have access to life event — such as losing other prescription drug coverage or moving to a new state — you may be able to switch plans outside the enrollment window. Call your current plan to ask whether your situation qualifies.

Talk to your doctor about whether a different blood pressure medication on your plan's formulary would work for you. Many ACE inhibitors and other blood pressure drugs are covered at lower copays. Your doctor can help you weigh the benefits and side effects of switching.

If cost is the main barrier, ask your doctor whether a patient information program from the manufacturer offers free or reduced-cost trandolapril. Some pharmaceutical companies run these programs for people who meet income requirements.

Questions to ask your doctor or pharmacist

Before you fill a prescription for trandolapril, ask your pharmacist what your copay will be and whether your plan requires prior authorization. If the cost is higher than you expected, ask whether a generic version or a different blood pressure medication on your plan's formulary might work instead.

Ask your doctor whether you need the brand name Mavik or whether generic trandolapril will work just as well. If your plan requires step therapy or prior authorization, ask your doctor to contact the plan on your behalf to explain why you need this specific medication.

If you are approaching the coverage gap, ask your pharmacist how many refills you can get before you hit it, and whether switching to a 90-day supply through mail order would lower your total cost for the year.

Frequently Asked Questions

Does Medicare Part B cover trandolapril?

No. Part B covers doctor visits, hospital care, and some medical equipment, but not prescription drugs taken at home. Only Part D covers trandolapril. If you have Original Medicare and no Part D plan, you pay the full cost out of pocket unless you have coverage from another source, such as a former employer or Medicaid.

Will my copay for trandolapril stay the same all year?

No. Your copay increases once you enter the coverage gap (donut hole), usually in the fall. Once you reach catastrophic coverage, your copay drops again. The exact timing depends on how much you and your plan spend on drugs each month.

Can I get trandolapril through a mail-order pharmacy to save money?

Yes. Many Part D plans offer lower copays for 90-day supplies through mail-order pharmacies run by the plan. Call your plan to ask whether mail order is available and what the copay would be. Delivery usually takes 7 to 10 days, so plan ahead for refills.

What if my doctor prescribed Mavik but my plan only covers generic trandolapril?

Ask your pharmacist to fill it with generic trandolapril instead. The medication is the same. If your doctor specifically needs you on the brand name for a medical reason, your doctor can request a prior authorization exception, though the plan may still require you to pay a higher copay.

Can I switch Part D plans if my current plan stops covering trandolapril?

Yes, during the annual open enrollment period from October 15 to December 7. Use Medicare.gov's Plan Finder to see which plans in your area cover trandolapril and compare copays. If you have a may have access to life event outside this window, you may be able to switch plans earlier — call your current plan to ask.