Ceftriaxone (Rocephin) Medicare Coverage

Ceftriaxone is an antibiotic medication used to treat infections including bloodstream infections, bone and joint infections, abdominal infections, brain infections, lung infections and more. The brand name equivalent of Ceftriaxone is called Rocephin.

Ceftriaxone works by inhibiting bacterial cell walls so infections can’t spread farther in the body. Ceftriaxone is given as an injection into a vein or muscle and can be used for up to 6 weeks or longer, depending on the type of infection you have.

Side effects common with Ceftriaxone include diarrhea and upset stomach. Some patients also experience irritation where the injection is given.

How much does Ceftriaxone cost with Medicare?

If Medicare Part B covers Ceftriaxone treatments for you because you meet the qualifying conditions, you’ll typically pay 0% to 20% of the Medicare-approved amount for the Ceftriaxone prescription price, after you meet your Part B deductible.

In 2024, the Medicare Part B deductible is $240 per year. Once you pay this amount, you’ll pay the remaining copay costs Medicare Part B doesn’t cover.

Does Medicare cover Ceftriaxone?

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Ceftriaxone coverage.¹ Medicare Part B covers certain drugs administered by health care professionals.

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Ceftriaxone, your Part B benefits will cover Ceftriaxone.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
• Part D plans or Medicare Advantage plans that cover drugs include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover prescription drugs. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Additional information

Ceftriaxone should only be given as an injection into the vein or into the muscle.

Let your doctor know if you experience pancreas symptoms, gallstone symptoms or kidney symptoms after taking Ceftriaxone.

• Signs of pancreas problems include stomach pain, back pain, upset stomach or vomiting.
  
  
• Gallstone symptoms may include pain in the abdomen, pain in the shoulder or between the shoulder blades, yellow skin or eyes or fever with chills.
  
  
• Signs of kidney problems may include changes in passing urine, pain while passing urine, weight gain or blood in the urine.

Anemia can happen while taking Ceftriaxone. Watch for signs of pale skin, dizziness, fever, chills, back or stomach pain or if you feel tired or weak.

Let your doctor know if diarrhea persists or if it becomes very severe.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.