Does Medicare Cover Hydrocodone? 

According to the Mayo Clinic, three out of 10 Americans live with persistent pain resulting from injury or illness. Our complicated central nervous system enables pain to develop and spread, sometimes making it difficult to pinpoint the underlying cause.

Pain can affect many aspects of your life, and can cause stress, depression, anxiety, lack of joy and social isolation. Some pain can be relieved by lifestyle changes, breathing exercises or meditation, increased physical activity, and abstinence from smoking and alcohol. External support can come from friends and family, physical therapy, behavioral therapy and support groups.

Unfortunately, some people need medication to help alleviate their chronic pain. If over-the-counter products are not effective, your doctor may prescribe a pain relief drug. Depending on the severity of your symptoms and overall health, pain management may include morphine, fentanyl, tramadol or hydrocodone.

The dangers of hydrocodone

The Controlled Substances Act (CSA) classifies analgesics (drugs prescribed to manage and treat pain) according to the drug’s medical purpose, potential abuse and liability (safety or dependence). The CSA classifies hydrocodone as a Schedule II narcotic (opiate). 

Hydrocodone is typically combined with acetaminophen (to relieve pain), ibuprofen (to reduce inflammation) or antihistamines (to relieve allergy symptoms like coughs). Brand names include Lortab, Verdrocet and Xodol. According to the National Center for Biotechnology Information, hydrocodone ranks high as one of the most common pain medications and one of the most abused.  

Medicare Part D for prescription drugs

If you have Part D, hydrocodone is likely covered, but check your plan’s formulary (list of covered drugs) to confirm. Several factors contribute to your cost-sharing responsibility. They include your policy deductible, required copayments, drug benefit phase and preferred pharmacy. If you need help paying for prescription drugs, you can apply to the Extra Help program. Eligibility criteria are based on annual income and other financial resources. 

If you have a Medicare Advantage policy that includes Part D, the same variables apply to cost-sharing, and you may need to choose a pharmacy within your plan’s network. If your plan does not cover hydrocodone, you can apply to a different Prescription Drug Plan during the annual Open Enrollment Period or, if applicable, Medicare Advantage Open Enrollment Period. 

Non-opioid drugs for pain include aspirin, ibuprofen and acetaminophen, which you can buy without a prescription. Medicare Advantage members often offer over-the-counter (OTC) benefits. In that case, you may be eligible for an allowance to purchase nonprescription pain relievers at no cost. 
Opioid addiction

Medicare beneficiaries who need opioid use disorder treatment may qualify for treatment services under Part B. Medicare offers in-person and sometimes virtual counseling, therapy and periodic assessments. Your cost is the Part B deductible. Original Medicare members using a Medicare-approved provider do not have to pay coinsurance, but Medicare Advantage plans may apply copayments. If you are looking for support, talk to your doctor or search the official Medicare website for a local Medicare-qualified program.