Medicare coverage for Aricept
Aricept (donepezil) is a tablet medication prescribed for people living with Alzheimer’s disease. Medicare drug plans may cover Aricept or its generic version, but the exact coverage and a person’s costs will vary based on their particular plan.
Oral medications may be covered by a stand-alone Medicare Part D plan or a Medicare Advantage Prescription Drug (MAPD) plan. Both types of plans are approved by Medicare but administered by private insurance companies.
This means that coverage of Aricept under a specific plan depends on whether the drug is included in that plan’s formulary (list of covered drugs).
Aricept can cost around $500 without insurance for a 30-day supply, while the cost of generic donepezil ranges between $9 and $60, depending on the dispensing pharmacy.
That said, a person’s copayment for medications under Medicare depends on the tier classification of the medication in the person’s plan. Generally, the higher the tier, the more one will pay out of pocket, with generic drugs typically falling into lower tiers.
However, starting in 2025, Medicare drug plans will limit annual prescription expenses to $2,000, after which the plan will fully cover the remaining medication costs.
In 2026, this cap is expected to increase to $2,100. Plus, there will usually be a deductible and premium for the drug plan, which will vary by plan. In 2025, the maximum deductible for any Medicare drug plan will not exceed $590.
Until recently, the Food and Drug Administration (FDA) had only approved medications that manage Alzheimer’s symptoms rather than treating the disease itself. These symptom-management drugs, including cholinesterase inhibitors like Aricept, have long been the standard treatment.
For this reason, Aricept is a commonly prescribed drug. Since Medicare drug plans are required to cover at least two drugs from the most frequently prescribed categories, many plans should cover this drug, its generic version, or a similar alternative medication.
That said, a significant development occurred when the FDA approved monoclonal antibodies like Leqembi (lecanemab), which target the beta-amyloid plaques thought to cause the disease. These treatments are administered through intravenous (IV) infusions, and Medicare Part B may cover them under certain conditions.