Does Medicare Cover Lidocaine Patches? 

If you’ve ever had dental work done you’ve probably heard of lidocaine, the most common local anesthetic that dentists use to block nerve pain. While lidocaine is used to treat other serious conditions like ventricular tachycardia, it is also available as a topical anesthetic in stick-on patches that you can use for any of the following reasons:

• To relieve acute pain
• To relieve pain from nerve disease 
• To ease chronic pain
• To ease pain caused by shingles

These days, you can find several different brands of lidocaine pain-relieving patches sold over the counter in most pharmacies and big-box department stores. Because you can buy them without a prescription, these brands are limited to a four percent lidocaine concentration. 

If your health care provider writes a prescription for lidocaine patches, you can get a brand that contains five percent lidocaine, which is the greatest concentration of lidocaine available in patch form. 

Does Medicare cover lidocaine patches? 

While basic Medicare insurance covers inpatient hospital care and outpatient medical care, you need an additional plan to get coverage for prescription medications that you can take yourself at home. If you’re enrolled in Original Medicare Part A alone, or together with Part B, you can enroll in a stand-alone Medicare Part D plan. 

If you’re enrolled in a Medicare Advantage (Part C) plan, your plan may already include prescription drug coverage. Today, most Medicare Advantage plans include prescription drug coverage together with the basic Medicare benefits. But if your plan doesn’t, you can switch plans during an enrollment period. When you’re eligible for an enrollment period, you’ll be able to switch to a different Medicare Advantage plan that includes prescription drug benefits, or you can switch back to Original Medicare and enroll in a Part D plan separately. You can take these actions during the Open Enrollment Period from October 15 through December 7. 

If your physician prescribes lidocaine patches, your prescription drug plan will most likely include them on its formulary. A Part D plan’s formulary is the official list of prescription drugs and medications that are covered. While all Part D providers are required to include at least two drugs in each category that are commonly used by Medicare beneficiaries, they have the option to include others, so check your plan’s formulary to ensure that lidocaine patches are there. 

How much do lidocaine patches cost with Medicare?

How much you pay as a copayment for lidocaine patches depends on how much your Part D plan charges. Medicare prescription drug plans classify the drugs they cover on tiers – typically from one to five – and each tier has its own copayment. Tier one drugs are commonly prescribed generic drugs with a low copayment. Tier five drugs are specialty drugs with the highest copayment. 

Today most Medicare Part D plans categorize lidocaine patches as tier-four drugs, and they carry a high copayment. If you aren’t sure about the classification or your out-of-pocket cost for the patches, you should call your provider for details. 

If you have a Medicare Advantage plan that offers a monthly allowance for over-the-counter medications and health care supplies, you might be able to purchase lidocaine patches using your membership card. However, the over-the-counter brands contain a lower percentage of lidocaine, so ask your physician if these are suitable for your needs. 

How much do lidocaine patches cost without Medicare coverage? 

The national average charge for prescription-strength (five percent) lidocaine patches runs between $20 and $50 per patch, depending on where you purchase them. For over-the-counter lidocaine patches (four percent), you will typically pay between $1 and $3 per patch, depending on where you buy them, and which brand you get.