Tegretol (Carbamazepine) Medicare Coverage

Tegretol is a medication that contains the active ingredient Carbamazepine.

Tegretol is used to treat hypomania, mild to moderate manic episodes, or mixed episodes associated with bipolar disorders. It is also used to treat focal and generalized onset seizures, as well as nerve pain.

This medication produces anticonvulsant effects, anti-nerve pain effects, muscle relaxant and antimanic effects, among others.

Common side effects of Tegretol include dizziness, drowsiness, upset stomach, dry mouth, constipation and fatigue.

How much does Carbamazepine cost with Medicare?

Carbamazepine 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 Carbamazepine?

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

• Medicare Advantage plans or Part D plans that cover Carbamazepine 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 Carbamazepine. 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

Take your dose of Tegretol with food.

Stopping this medication suddenly can lead to withdrawal symptoms and can increase seizure frequency. It is important to gradually stop taking Tegretol over a period of 2-6 months as directed by your doctor in order to avoid these negative effects.

A specific type of anemia and low white blood cell count can happen while taking Tegretol. Tell your doctor if you experience any fever, chills, shortness of breath, fatigue or any unexplained bleeding or bruising.

Some symptoms such as fever, chills, shortness of breath, sore throat, cough or sinus pain can indicate an infection that you should talk to your doctor about right away.

A bad skin reaction can occur while taking Tegretol. Signs of this skin reaction can include red, blistered or peeling skin, red or irritated eyes, or sores on your mouth and skin.

This skin reaction can become very serious. It is important to talk to your doctor immediately if you notice these signs and symptoms.

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.