{"id":634493,"date":"2025-12-02T13:51:00","date_gmt":"2025-12-02T18:51:00","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=634493"},"modified":"2026-01-28T13:41:30","modified_gmt":"2026-01-28T18:41:30","slug":"brilinta-medicare-coverage-and-costs","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/brilinta-medicare-coverage-and-costs\/","title":{"rendered":"Brilinta Medicare coverage and costs"},"content":{"rendered":"

Brilinta<\/span><\/a> is the brand name for<\/span> ticagrelor<\/span><\/a>, which is a type of antiplatelet medication. It works by stopping platelet formation in your blood, which reduces the chances of blood clots and decreases the risk of heart attacks, strokes, and other cardiovascular issues. Brilinta is FDA-approved to be used in the prevention of heart attacks and acute ischemic stroke in people who have had them in the past, and for reducing the risk of cardiovascular events in high-risk people with coronary artery disease.<\/span><\/p>\n

If you\u2019re on Medicare and you\u2019ve been prescribed Brilinta for the prevention of heart attacks or strokes, you may be wondering if Medicare will cover the cost of the medication. While Medicare Part D often covers Brilinta, you may need to meet certain criteria to ensure coverage, and you may also have out-of-pocket expenses like<\/span> deductibles<\/span><\/a> and copayments.<\/span><\/p>\n

Does Medicare cover Brilinta?<\/span><\/h2>\n

Yes, Medicare does typically cover Brilinta.<\/span> Medicare Part D<\/span><\/a> is the portion of Medicare that covers prescription drugs. However, each Medicare Part D plan is unique, and coverage can vary from one plan to another. Each privately-administered Medicare Part D plan has it\u2019s own unique list of covered drugs, or formulary.<\/span><\/p>\n

\u201cAs a pain management doctor, I often see patients who are taking heart medications like Brilinta (ticagrelor) alongside their pain treatments,\u201d says Sean Ormond, MD, dual board-certified in anesthesiology and interventional pain management physician at<\/span> Atlas Pain Specialists<\/span><\/a>. These patients often have many questions and concerns about their coverage.<\/span><\/p>\n

In Dr. Ormond\u2019s experience, \u201cmost Medicare Part D plans do cover Brilinta, but not all cover it the same way,\u201d he explains. \u201cIt\u2019s often considered a higher-tier brand-name drug, which can mean a higher copay.\u201d The copay<\/a> amount can vary from one plan to another. You can contact your Medicare plan to obtain more information about your copayment amount.<\/span><\/p>\n

According to Elizabeth Rubin, MD, an emergency medicine physician and clinical advisor at<\/span> Embers Recovery<\/span><\/a>, while Medicare often does cover Brilinta, your coverage and out-of-pocket expenses can depend on your health insurance plan\u2019s specific<\/span> formulary<\/span><\/a>, which is an insurance company\u2019s list of covered medications. \u201cMost Part D plans list Brilinta as a Tier 3 or Tier 4 brand-name drug, which often comes with higher copays or coinsurance,\u201d she explains. If your Part D plan does not list Brilinta on its formulary, you may need to ask your doctor to prescribe another appropriate medication, or you can ask your doctor to request an exception to your plan with an explanation of why the medication is medically necessary.\u00a0<\/span><\/p>\n

You can also look to switch Medicare Part D plans during the annual enrollment period to a plan that covers all of your prescriptions with as few restrictions as possible.<\/span><\/p>\n

In addition, certain criteria often need to be met in order for Medicare to cover Brilinta.<\/span><\/p>\n

Documentation of medical necessity<\/span><\/h3>\n

\u201cSome plans may ask your doctor to show that the medication is medically necessary\u2014basically, that Brilinta is the best option for your heart condition,\u201d Dr. Ormond explains. This might mean that your health care provider needs to provide documentation of your specific medical diagnosis to the insurance company.<\/span><\/p>\n

Prior authorization<\/span><\/h3>\n

Some plans require<\/span> prior authorization<\/span><\/a>, explains Dr. Rubin. This is especially likely if the patient is starting therapy outside of an acute coronary syndrome (ACS) or post-stent indication, she shares. \u201cIn those cases, physicians may need to document medical necessity and confirm that Brilinta is being used according to current cardiology guidelines,\u201d Dr. Rubin explains.<\/span><\/p>\n

Step therapy<\/span><\/h3>\n

Step therapy<\/span><\/a> is a restriction whereby you are mandated to try a similar but less expensive medication before your insurance company approves the medication you want to take. According to Dr. Rubin, this is less likely to happen with Brilinta, but it\u2019s possible. \u201cWhile uncommon, step therapy may apply if the plan prefers a lower-cost alternative like clopidogrel,\u201d she explains.<\/span><\/p>\n

How much does Brilinta cost with Medicare?<\/span><\/h2>\n

According to the<\/span> manufacturer\u2019s website<\/span><\/a>, Brilinta costs $45 or less per month for most Medicare Part D recipients. But using a SingleCare savings card could make the costs even less. People who use a SingleCare savings card to pay for Brilinta usually pay about<\/span> $31<\/span><\/a> at CVS. Note that you can\u2019t use your Medicare Part D benefits along with your SingleCare card.<\/span><\/p>\n

Brilinta assistance for Medicare patients<\/span><\/h2>\n

SingleCare coupons<\/span><\/h3>\n

If your plan doesn\u2019t cover Brilinta, SingleCare can help. The way that<\/span> SingleCare coupons work<\/span><\/a> is that you simply text, email, or print the coupon you want to use and then present it to your pharmacist when it\u2019s time to pick up your medication. SingleCare coupons are free, without my hidden costs.<\/span><\/p>\n

You can use a SingleCare coupon for Brilinta and also for the generic version of Brilinta, Ticagrelor. In both cases, you can save significant money. For example:<\/span><\/p>\n