Medicare Coverage for Ondansetron

Ondansetron is the generic form of Zofran, a medication used to treat nausea and vomiting. Your Medicare Part D or Medicare Advantage Plan may cover ondansetron or a similar medication. Read on to learn more about how this medication is used and find out whether Medicare covers it.

What Is Ondansetron Used For?

Ondansetron helps control nausea and vomiting caused by radiation therapy and chemotherapy. It may also be used to prevent nausea and vomiting after surgical procedures. This medication is available as a dissolvable liquid, a dissolvable tablet and an oral tablet. Some of the most common side effects of ondansetron include diarrhea, headache, fatigue, anxiety and constipation.

Is Ondansetron 4 mg a Narcotic?

Ondansetron 4 mg isn't a narcotic. It's a serotonin 5-HT3 receptor antagonist, which means it blocks the effects of serotonin, a natural chemical that may cause nausea and vomiting.

Does Medicare Cover Ondansetron?

Ondansetron is covered by all Medicare Part D and Medicare Advantage plans. If you're like many Medicare Advantage enrollees, your plan covers prescription drugs. In fact, 88% of all Medicare Advantage enrollees belong to plans that include prescription coverage. These plans are known as Medicare Advantage Prescription Drug Plans (MA-PDs).

If you're enrolled in Original Medicare, which doesn't include outpatient prescription coverage, you may have a Part D plan. Medicare Part D covers a variety of prescription drugs, including ondansetron. Each plan has a formulary, or a list of drugs that are covered by the plan. Drug formularies are usually organized according to tiers, with drugs on lower tiers costing less than drugs on higher tiers.

Drug coverage varies by plan, but you should be able to find a Medicare Advantage plan that covers ondansetron and is available in your state.

Out-of-Pocket Costs

The cost of ondansetron and other medications depends on the terms of your Medicare plan. Costs also vary based on whether you've paid your full deductible. In insurance terms, a deductible is the amount of money you must pay before your coverage kicks in. Medicare prescription drug plans have a maximum deductible of $545 for 2024, but many plans have much lower deductibles. Some plans even have $0 deductibles, meaning they start covering prescription medications right away. Once you meet your deductible, ondansetron may cost as little as $0 to $2 per refill.

Safe Use of Ondansetron

Because ondansetron blocks the effects of serotonin, frequent use may cause a condition known as serotonin syndrome. If you experience confusion, agitation, loss of balance, fever, flushing, abnormal heartbeat, shaking, sweating or muscle problems, contact your doctor right away. You should also contact your doctor immediately if you pass out while using ondansetron. Passing out could be a sign of a serious heart condition.

If your doctor prescribes dissolvable tablets, you don't need to take them with water. Simply place one of the tablets under your tongue and wait for it to dissolve completely.