{"id":634758,"date":"2025-12-18T18:01:17","date_gmt":"2025-12-18T23:01:17","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=634758"},"modified":"2025-12-18T18:01:17","modified_gmt":"2025-12-18T23:01:17","slug":"is-gemtesa-covered-by-medicare","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-gemtesa-covered-by-medicare\/","title":{"rendered":"Is Gemtesa covered by Medicare?"},"content":{"rendered":"

People with <\/span>overactive bladder<\/span> (OAB) syndrome received another treatment option when <\/span>Gemtesa<\/span><\/a> (<\/span>vibegron<\/span>) hit the market in 2020. However, as with many other new medications, some people learned that their <\/span>health insurance <\/span>didn\u2019t cover the <\/span>cost of Gemtesa<\/span><\/a>. With <\/span>Medicare<\/span>, <\/span>drug costs<\/span>, including the <\/span>cost of Gemtesa<\/span>, often depend on the recipient\u2019s supplemental drug coverage.<\/span><\/p>\n

Here\u2019s what to know if you have <\/span>Medicare<\/span> and want to take <\/span>Gemtesa<\/span> to address <\/span>OAB,<\/span> but are concerned about the price.<\/span><\/p>\n\t\t

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\n\t\t\t\t
\n\t\t\t\t\tGemtesa 75 mg (30 Tablets)\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t23666 - Hampton, VA\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t
\n\t\t\t\"Kroger\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$441.90\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
\n\t\t\t
\n\t\t\t\"Harris\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$441.90\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\tSee Gemtesa prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t\n

Does <\/b>Medicare cover<\/b> Gemtesa<\/b>?<\/b><\/h2>\n

Gemtesa<\/span><\/a> is designed to treat <\/span>overactive bladder<\/span> (<\/span>OAB<\/span>) in adults, as well as <\/span>adult males who are also taking medicine for benign prostatic hyperplasia (BPH).<\/span><\/p>\n

Sometimes <\/span>Medicare covers<\/span> the <\/span>cost of Gemtesa<\/span>, and sometimes it doesn\u2019t.<\/span><\/p>\n

\u201cFrom my experience, coverage has really broadened over the past year, but it still varies by plan,\u201d says Dr. Erika Alexander, <\/span>Pharm.D.<\/span>, a clinical pharmacist with <\/span>MOBE<\/span><\/a>.<\/span><\/p>\n

\u201c<\/span>Vibegron<\/span> has been a great addition\u2014very effective, very well tolerated, and without the drug interaction issues we sometimes see with <\/span>mirabegron<\/span>. My patients often like it,\u201d says <\/span>Dr. Justin Houman, MD<\/span><\/a>, urologist and surgeon, comparing <\/span>vibegron<\/span> to another <\/span>OAB<\/span> treatment that is marketed under the <\/span>brand-name<\/span> Myrbetriq<\/span><\/a>. \u201cThe challenge is coverage,\u201d he adds.<\/span><\/p>\n

In fact, a recent<\/span> study<\/span><\/a> in the journal <\/span>Urogynecology (Phila) <\/span><\/i>found that <\/span>beta-3 adrenergic agonists<\/span>, which include both<\/span> vibegron<\/span><\/a> and<\/span> mirabegron<\/span><\/a>, tend to have the worst <\/span>insurance coverage<\/span> nationwide.<\/span><\/p>\n

Why is it sometimes not covered?<\/b><\/h2>\n

Prescription drug coverage<\/span> can vary widely, depending on the type of insurance you have and its drug <\/span>formulary<\/span>. Sometimes, <\/span>insurance plans<\/span> only cover certain medications within a particular category, or they may not cover a specific medication if less expensive alternatives are already available.<\/span><\/p>\n

People who have <\/span>Medicare<\/span> can get <\/span>prescription drug coverage<\/span>, or <\/span>Medicare Part D<\/span>, in one of<\/span> two ways<\/span><\/a>:<\/span><\/p>\n