Does Medicare Cover Soltamox?

The last thing you need after a breast cancer diagnosis is to worry about how to afford your treatment. Fortunately, your health insurance will often cover the essential medications used to treat breast cancer. This guide outlines how Medicare coverage for Soltamox works. 

What Is Soltamox?

Soltamox is a branded version of tamoxifen; an estrogen receptor antagonist used to treat and prevent breast cancer. It prevents estrogen from binding to cancer cells and signaling them to multiply. 

Soltamox comes as a liquid solution, but some other tamoxifen brands come in tablet form. Doctors often prescribe this medication after diagnosing early-stage hormone receptor-positive breast cancer or following surgery, and you'll usually continue taking the drug for at least 5 years. However, it can also be used to treat advanced cancer for as long as the benefits outweigh any adverse effects. 

Soltamox Side Effects

This medication can cause side effects, and you should consult your doctor if your symptoms are severe. Common side effects include:

• Nausea
• Depression and mood changes
• Hair loss
• Constipation
• Skin dryness
• Hot flashes

Does Medicare Cover Soltamox?

Soltamox is covered by 100% of Medicare Part D plans. It's a relatively expensive drug, so it usually appears on the top tier (Tier 5) of Medicare Part D formularies.

How Much Does Soltamox Cost With Medicare?

Some Medicare Part D plans may cover Soltamox before you meet your deductible, which can't exceed $545 as of 2024. Otherwise, you'll need to pay for Soltamox yourself until you spend an amount equivalent to the deductible, which can vary between companies. 

Soltamox typically retails at around $1,558 for two 150-milliliter bottles, although it's worth checking with several pharmacies to see if you can get your medication for a lower price. As the price exceeds the legal maximum for Medicare Part D deductibles, you'll usually pay $545 toward the cost of your first prescription, and your insurer will cover the balance and any further prescriptions.

However, you're also liable to pay a co-pay every time you receive coverage. Fortunately, co-pays for Soltamox are usually modest, with most insurers charging between $1 and $5. 

Are There Any Soltamox Coverage Restrictions With Medicare?

Many Medicare Part D providers offer unrestricted coverage for Soltamox. However, some may require your prescribing physician to contact the company to verify why the medication is medically necessary or restrict how much medication it covers at a time.