Does Medicare Cover Prandin?

According to the CDC, around 90% to 95% of the 37 million Americans living with diabetes have type 2 diabetes. You can often manage type 2 diabetes with lifestyle changes, but some people require medications, such as Prandin, to stay healthy. The drugs used to treat type 2 diabetes can be expensive, so it's worth checking whether your Medicare plan covers Prandin and similar medications. 

What Is Prandin?

Prandin is a branded version of repaglinide. Repaglinide stimulates insulin production to reduce blood sugar levels. Your doctor may recommend taking Prandin or another repaglinide medication to control your blood sugar if you have type 2 diabetes. 

Dosage requirements vary from person to person, but you should usually take Prandin before a meal. Eating healthily while taking Prandin is essential to achieve the best results, and you should consult your doctor first if you intend to drink alcohol. 

Prandin Side Effects

Occasionally, taking Prandin can cause hypoglycemia (low blood sugar.) Follow your health care provider's instructions for treating hypoglycemia if you develop symptoms such as shakiness, dizziness or pale skin. Prandin can also cause side effects, including:

• Stuffy nose
• Headache
• Painful joints
• Constipation
• Diarrhea

Does Medicare Cover Prandin?

Original Medicare enrollees aren't generally eligible for Prandin coverage because Parts A and B only cover physician-administered medications in limited circumstances. However, you can buy additional prescription drug coverage (Part D) from private health insurers. 

Most Medicare Part D policies cover repaglinide, with 96% of insurers covering the medication in some form. It's unclear how many providers cover the Prandin brand specifically.

Medications containing repaglinide are relatively affordable, so you can often determine your coverage by checking the lowest tier (Tier 1) of your insurer's policy. If Prandin doesn't appear on the list of covered drugs, your health care provider may prescribe a generic version covered by your insurance. 

How Much Does Prandin Cost With Medicare?

Your Part D insurer won't usually pay for prescription medications until you meet your deductible, although there are exceptions. For example, some insurers may cover certain essential drugs regardless of whether you've met your deductible. Others may set $0 deductibles, although deductible-free plans are relatively rare and tend to cost more. 

Assuming your plan has a deductible, you must spend at least that amount on prescription medications before your insurer takes over. Part D deductibles vary between insurance companies, but can't be more than $545 in 2024, up from $505 in 2023. 

Prandin costs around $263.04 for 90 tablets at 1 mg each, although retail prices vary by pharmacy and geographic area. You could potentially save a lot of money by enrolling in a prescription drug discount program or shopping around to find the most reasonable prices.

Once you've paid your deductible, your insurance company pays for any further prescriptions. Part D insurers typically charge co-pays of $1 or less for Prandin.

Medicare Coverage Restrictions for Prandin

You don't usually need written authorization from your doctor to get Part D coverage for Prandin. However, many insurance companies set quantity restrictions for repaglinide medications such as Prandin. Therefore, your pharmacist can only fill a certain amount each time you receive a prescription from your doctor.