Does Medicare Cover Treatment for Angioedema

Does Medicare Cover Treatment for Angioedema? 

Angioedema causes swelling in the deeper layers of your skin. A build-up of fluid is the main cause, and it usually affects your hands, feet, lips, eyes, and genitals. You may also experience hives, and there are a few different forms of angioedema you can have. The treatment depends on the type, and your Medicare coverage may help to pay for part of your prescriptions. 

Types of Angioedema

What causes this condition depends on the type you have. Currently, there are four main types, including: 

• Allergic Angioedema – This type comes from an allergic reaction, and it can appear in combination with anaphylaxis if your reaction is severe enough. 
• Drug-Induced Angioedema – This type comes as a side effect from certain medications, including ACE inhibitors. 
• Idiopathic Angioedema – If there is no known cause for the swelling, it’ll fall under this category. Infections or stress can trigger the symptoms. 
• Hereditary Angioedema – You’ll inherit this type of angioedema from your parents. 

Diagnosis and Treatment

Your doctor will examine the affected skin and look at your symptoms. They may also want to perform an allergy or blood tests to find out which type of angioedema you have. If they can’t find a cause, they may diagnose you with idiopathic angioedema. 

If you have allergic or idiopathic angioedema, the typical treatment involves taking antihistamines and oral steroids. For drug-induced angioedema, you’ll usually get an alternative medication to treat your underlying condition. It won’t cure this condition, but it can prevent people from hereditary angioedema from experiencing attacks.

Medicare Benefits and Angioedema Treatment

There are several medications doctors use to treat angioedema, and it all depends on the type you have. This means that your Medicare benefits may help to cover the cost of these medications, depending on their formulary. 

Antihistamines

These medications work to block the histamine protein that can cause skin swelling. It’s common to take a two-week course of Cetirizine or Fexofenadine. You can get Cetirizine over the counter, so Medicare usually doesn’t cover it. You’ll need a prescription for Fexofenadine, and it will cost around $20.00 for a two-week course. Medicare Part D may help cover the cost. 

Corticosteroids

This type of medication can block some of your immune system’s actions. You’ll typically get a three to five-day course of corticosteroids. Prednisone is popular, and it costs around $15.00. If you need steroid injections, an immunologist or allergy specialist will usually inject them in an outpatient setting. These shots can cost around $100 per injection, and Medicare coverage can help pay for it if the doctor and the facility accept Medicare assignment and it’s medically necessary. 

Danazol

This is a synthetic hormone that can help prevent symptoms of hereditary angioedema. It works by helping to increase your body’s levels of C1-in protein, and it usually costs $150, but it can go up to $500. This is a prescription drug that Part D could help pay for. 

Tranexamic Acid

This is a popular alternative to danazol, and it can be just as effective with some patients. It may not have as many side effects, but it’s more common for use with women. The typical cost range starts at around $150, and Medicare typically covers it. 

Icatibant

This is a newer medication that treats short swelling episodes. It can block some chemical effects that can cause swelling with hereditary angioedema. This is an injection that typically has two shots per treatment, and your doctor can perform it in an outpatient setting. The cost for this injection is around $3,000. Some Medicare coverage includes this drug, and some don’t, so be sure to check with your plan’s formulary.