Medicare and Medicaid cover risk-reducing medications

In this section, we provide information about coverage of medication to reduce the risk of cancer under:

• Medicare
• Medicaid
   

Medicare

Ovarian, Endometrial and Uterine Cancer

Hormonal contraceptives, such as birth control pills or patches, have been shown to lower the risk of ovarian and endometrial/uterine cancer. If you have Medicare Part D prescription drug coverage, your benefits may pay for some types of hormonal contraceptives. Each Medicare D plan has its own list of prescription drugs, called a formulary. The type of birth control your plan covers is listed on its formulary. All formularies have at least 2 options of drugs for every category. They offer a generic brand as well as a brand-name drug option. Pricing can vary based on brand name versus generic options, and if you use an in-network pharmacy or mail order service.

Breast Cancer

All Medicare Part D and Medicare Advantage plans cover Tamoxifen, raloxifene and aromatase inhibitors with a little or no copay for the patient.

Medications, including statins (typically used to lower cholesterol levels) and aspirin, have been studied for their potential role in reducing the risk of certain cancers, preventing recurrence and/or increasing survival. While Medicare may not cover these medications at 100%, they are often available with a small copay or out-of-pocket cost.

Visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227) to learn more about the medications covered under your plan.
 

Medicaid

Ovarian, Endometrial and Uterine Cancer

While eligibility and benefits vary by state, most Medicaid programs offer free contraceptives, although they are not required to cover all FDA-approved birth control methods.  About half of the states have expanded family planning services and access to hormonal contraceptives for people who have a low income and would not otherwise be eligible for Medicaid.

Breast Cancer

Under existing law, state Medicaid programs must cover all of the drugs of a manufacturer if it has is a Medicaid rebate agreement. This requirement ensures relatively broad access to cancer-related drugs and therapies, including those that reduce cancer risk.  

Medications, including statins (typically used to lower cholesterol levels) and aspirin, have been studied for their possible role in reducing the risk of certain cancers, preventing recurrence and/or increasing survival. Medicaid typically covers these with a little or no copay or out-of-pocket cost if they are prescribed by a medical professional

Contact your Medicaid office to learn more about access to risk-reducing medications in your state.