Pantoprazole (Protonix) Medicare Coverage

Pantoprazole is a generic medication typically used to treat heartburn and stomach ulcers. The most common brand name equivalent of Pantoprazole is Protonix.

Pantoprazole is a proton pump inhibitor that suppresses your stomach from producing acid. This helps relieve heartburn.

You can get Pantoprazole over-the-counter or by prescription from your doctor. The most common side effects of Pantoprazole include headache, upset stomach, diarrhea, joint pain, common cold symptoms and gas.

How much does Pantoprazole cost with Medicare?

Pantoprazole 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 Pantoprazole?

According to GoodRx, 100% of Medicare Advantage plans and Medicare Part D plans covered Pantoprazole in 2023.¹

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

If you are taking Pantoprazole for the prevention of heartburn, take Pantoprazole 30 to 60 minutes before you eat a meal.

It is recommended that you do not take Pantoprazole for more than 14 consecutive days in a 4-month period unless instructed by your doctor.

Pantoprazole has been shown to contribute to osteoporosis when taken for long periods of time. Make sure you monitor for any signs of fracture in the hip, spine, wrist or other parts of the body.

The best practice is using the lowest effective dose for the shortest amount of time.

Pantoprazole can interact with many other drugs. If you buy it over the counter, be sure to check with your doctor or pharmacist that it is safe to take with your other medications.

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.