ProThelial (Sucralfate) Medicare Coverage

ProThelial is a medication used to treat mouth sores, mouth irritation and canker sores. ProThelial can also be used to treat oral mucositis, which can often be caused by chemotherapy or radiation treatment related to cancer.

ProThelial adheres to the surface of the mouth to form a barrier over the irritated areas to protect from more irritation and pain. It comes as a paste for the mouth and is used 2-3 times daily as needed.

ProThelial contains the active ingredient Sucralfate, which itself is sometimes used to treat internal ulcers of the stomach and intestine.

There are typically no side effects from ProThelial.

How much does Sucralfate cost with Medicare?

Sucralfate coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Sucralfate ?

According to GoodRx, 100% of Medicare Advantage plans and Medicare Part D plans covered Sucralfate , the generic form of ProThelial, in 2023.¹

• Medicare Advantage plans or Part D plans that cover Sucralfate 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 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
  
  
• 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 Sucralfate . We represent carriers such as Humana, Aetna, UHC, Anthem BCBS, Wellcare, Cigna Healthcare, and 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

The maximum approved duration of ProThelial use is 30 days, though you should use ProThelial for the amount of time that is prescribed by your doctor.

Do not eat or drink for at least 1 hour after using ProThelial. Only apply it to the parts of the mouth that are irritated or those that have lesions.

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.