Does Medicare Cover Jublia? 

If your physician tells you that you have contracted onychomycosis or tinea unguium, you might panic. But those are just complicated names for a common condition – fungal nail infection. Some of the most common symptoms of this condition are: 

  • Thick nails
  • Brittle nails
  • Nails with white or yellow streaks
  • Flaking on the nail’s surface
  • Yellow spots on the base of the nails

You might be more susceptible to toenail or fingernail fungal infections if you’re elderly, have a history of athlete’s foot, have psoriasis, or are diabetic. 

Your physician might prescribe oral antifungal medication or a topical antifungal cream like Jublia to treat your fungal infection before it becomes serious enough to cause health problems. Jublia is the brand name of the drug efinaconazole, which is a triazole antifungal medication that you can apply topically to affected nails. 

Does Medicare cover Jublia? 

Because Jublia is a prescription medication that you can take yourself at home. It isn’t covered by Original Medicare Part B (medical insurance). You may have coverage for Jublia prescriptions if you are enrolled in a Medicare prescription drug plan. If you have Original Medicare, you can enroll in a stand-alone Medicare Part D plan. If you have a Medicare Advantage (Part C) plan, your plan might include prescription drug coverage bundled with your other benefits. 

All Medicare prescription drug (Part C) plans must cover at least two medications in each drug class, including antidepressants, antipsychotics, chemotherapy drugs, HIV/AIDS drugs, immunosuppressants, and seizure drugs. Part D plans must also cover drugs that are commonly prescribed to Medicare enrollees like those to treat high blood pressure or asthma. However, even with these requirements, each Part D plan has options regarding which drugs it can list on its formulary (list of covered drugs). 

Because Jublia is an expensive specialty prescription medication that isn’t widely used by Medicare enrollees, it isn’t typically covered by Medicare prescription drug plans. If you’re already enrolled in a Medicare prescription drug plan, check your plan’s formulary to see if it’s covered. If you don’t see it, you can call your provider to get more details. If your Part D plan covers Jublia, your copayment amount depends on which tier your plan categorizes it. 

How much does Jublia cost without Medicare coverage? 

How much you pay for your prescription of Jublia depends on where you purchase it. Without insurance or coupons, the national average cost for a four ml bottle of Jublia topical solution of 10 percent strength is about $685. Depending on the retailer you purchase it from, you might be able to get coupons and save up to 75 percent of the retail price.  

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