Gemtesa Medicare cost: How much you’ll pay in 2025

In this article:

• How Medicare covers prescription drugs
• Does Medicare cover Gemtesa?
• How much does Gemtesa cost with Medicare?
• How to save on Gemtesa

In this article

• How Medicare covers prescription drugs
• Does Medicare cover Gemtesa?
• How much does Gemtesa cost with Medicare?
• How to save on Gemtesa

Gemtesa (vibegron) is a beta-3 adrenergic agonist that’s FDA approved to treat overactive bladder (OAB). It’s a prescription medication that can be pricey without insurance. Medicare coverage for Gemtesa varies by plan. When it’s covered, Gemtesa is typically listed as a non-preferred brand, which usually means you’ll pay a percentage of the retail cost as coinsurance. Fortunately, new Medicare Part D rules limit your total out-of-pocket spending to $2,000 per calendar year. Below, we’ll look at Gemtesa Medicare costs in more detail. 

How Medicare covers prescription drugs

Medicare Part D plans cover prescription drugs. Different insurance companies administer these plans, and each company decides which drugs it will cover on its formulary. There are six drug classes that must always be covered, but urological antispasmodic medications (those that relax the bladder muscles) like Gemtesa aren’t bound by this rule.

Each health insurance company publishes a list of drugs that it covers in a document known as a formulary or drug list. Formularies vary by plan. 

If Gemtesa is in your plan’s formulary, it will be assigned a tier number (one through five). The higher the tier number, the more you can generally expect to pay out of pocket. The exact coinsurance percentage or flat-rate co-pay depends on the terms of your plan. 

Does Medicare cover Gemtesa?

Yes, some Medicare plans cover Gemtesa, but not all do. We looked at formularies from six popular Medicare providers and found that one-third of these randomly chosen plans  didnt cover Gemtesa. 

Other insurance plans will have different formularies than the ones we looked at, so it’s always best to check your plan’s formulary to confirm prescription drug coverage.

How much does Gemtesa cost with Medicare?

Because Medicare Part D formularies and out-of-pocket drug costs vary, it’s difficult to come up with an average cost of Gemtesa with Medicare. 

That said, we found four drug lists that cover Gemtesa, and all of them categorize it as a Tier 4 medication. This typically means that, for those plans, you’ll pay around 30%–40% of the drug’s retail price as co-insurance. Since Gemtesa costs an average of $689 for 30, 75 mg tablets, you can expect to pay about $204–$272 for this prescription each month with this type of Medicare Part D plan. 

In 2025, the out-of-pocket maximum for Medicare Part D recipients is $2,000. This means the last few prescriptions of the year would cost nothing out of pocket if you started paying for Gemtesa at the beginning of the calendar year. You may reach the out-of-pocket maximum sooner if you also pay for other prescriptions. 

Also, the Medicare coverage gap, or “donut hole,” is gone, so you no longer have to pay more for your prescription drugs after reaching a certain limit. 

How to save on Gemtesa

Whether your Medicare plan covers Gemtesa or not, there are ways to save money on this prescription. 

Gemtesa coupons

A SingleCare prescription discount card could save you about $260 on your Gemtesa prescription, lowering it from $689 to $427. This coupon card can’t be combined with Medicare savings, so it’s best to use it if you don’t have insurance coverage for Gemtesa. 

To use a SingleCare card, sign up for a free SingleCare account and head to the Gemtesa coupons page. Enter your ZIP code to compare prices across pharmacies. Then tap “Get Free Coupon” to generate your SingleCare savings card to use at your chosen pharmacy. Print it or save a digital copy to your SingleCare account. You can also forward it to yourself via email or text.

When you pick up your Gemtesa prescription, simply show your SingleCare coupon or card to the pharmacy staff to redeem your savings. 

Medicare Extra Help Program

Medicare recipients with limited incomes and resources may qualify for the Medicare Extra Help program. Income and resource limits vary by year. If you’re eligible, you’ll generally pay no premiums or deductibles, and covered brand-name drugs like Gemtesa will cost a maximum of $12.15 for each refill in 2025. 

Gemtesa alternatives

Your healthcare provider may recommend Gemtesa alternatives that are either covered by your Medicare plan or more affordable for out-of-pocket payments. 

For example, generic oxybutynin chloride extended-release (ER) may be more likely to be covered by Medicare than Gemtesa and requires a smaller copay or coinsurance. Even if you had to pay completely out of pocket for oxybutynin chloride ER, 30, 10 mg tablets cost less than $10 with a SingleCare coupon. 

However, cost is just one thing to consider when discussing alternatives with a healthcare professional. Some overactive bladder treatments may be associated with unpleasant side effects or potentially interact with other medications.

“For some patients, anticholinergic agents (e.g., oxybutynin, solifenacin, or tolterodine) may be cheaper, but they come with a higher risk of side effects such as cognitive impairment, constipation, and dry eye and mouth,” says Jason B. Carter, a urologist based in Greeneville, Tennessee and a medical adviser at Aeroflow Urology.

He suggests Myrbetriq (mirabegron) as an alternative to Gemtesa because it belongs to the same drug class and “is more widely covered and offers similar efficacy.” Sure enough, the Medicare formularies we spot-checked that don’t cover Gemtesa do cover name-brand Myrbetriq or generic mirabegron. Dr. Carter warns that Myrbetriq may raise blood pressure in some people, which generally isn’t the case with Gemtesa. 

Other overactive bladder treatments

Lopa Pandya, a reconstructive pelvic surgeon at the Department of Obstetrics & Gynecology at UI Health and a medical adviser at Aeroflow Urology, says overactive bladder may be treated without the use of pharmaceuticals, which may be more affordable in the long run. 

“First, we consider behavioral modifications, like what kind of fluid intake someone has, and modifying that. Anything caffeinated or carbonated is going to impact the bladder, and alcohol will worsen symptoms as well,” she explains. 

Dr. Pandya says some people notice that spicy food triggers their overactive bladder symptoms, and that losing weight may improve symptoms. Aside from lifestyle changes, she also recommends pelvic floor therapy because “your pelvic floor muscles can impact how the bladder functions.”  

Finally, there are several procedures to treat an overactive bladder that may be covered under Medicare Parts A and B. “One is intradetrusor botox to help relax the bladder muscle,” Dr. Pandya explains. “There are also two approaches that impact the nerves of the bladder. One is called PTNS (percutaneous tibial nerve stimulation), which is basically where an acupuncture-like needle is put in a nerve near the ankle and hooked up to a stimulator. Typically, this is done over 12 weekly sessions.” 

The second nerve-impacting approach requires surgery to implant a device that stimulates nerves near the base of the spinal column for better bladder control. As the most invasive option, it’s usually recommended for people who have tried other treatments with little to no success. 

What about the manufacturer’s savings card?

Sumitomo Pharma, the makers of Gemtesa, offer the Simple Savings Program to help people afford their Gemtesa prescription. Unfortunately, having or being eligible for Medicare disqualifies you from the program. 

If you’re being treated for an overactive bladder, check your Medicare Part D plan to see which treatments it covers, and share them with your healthcare provider. They can evaluate your options and help you choose the best treatment for you based on any other health conditions or medications you’re taking.