Does Medicare cover Zyban? 

Your efforts to stop smoking are applauded. Quitting is not easy, but it’s the right step toward improving your health. The American Cancer Society (ACS) reports that smoking cessation lowers your risk of developing all cancers caused by smoking, and even adults in their 60s and older benefit from quitting. 

You can get help by participating in individual or group counseling, trying nicotine replacement products, and talking to your doctor about medication that may help you quit and reduce withdrawal symptoms.

Does Medicare Part D help cover Zyban?

Zyban, which received approval from the Federal Drug Administration (FDA) in 1997 to help people stop smoking, contains bupropion hydrochloride. The FDA approved bupropion in 1985 for adult depression, smoking cessation and seasonal affective disorder (SAD). Bupropion is also on the market under the brand name Wellbutrin. Medicare only covers drugs that receive FDA approval.

If you have a Medicare Prescription Drug Plan (a stand-alone Part D policy) or prescription drug coverage as part of your Medicare Advantage plan, your plan’s formulary is your guide for covered medication. Insurers generally present a formulary in tiers of cost. 

When you find your prescribed drug in your plan’s formulary, compare any benefit limitations to your doctor’s prescription. Look at dosage, quantity limit (QL), immediate-release (IR) and extended-release (ER) coverage. Every Part D policy differs in cost, so your cost depends on your plan’s deductible and coinsurance or copay requirements.

How can Medicare Part B help you stop smoking?

Part B covers face-to-face cessation counseling to prevent tobacco use and the diseases smoking can cause. The benefit includes up to eight sessions within a 12-month window. If you have Part B, use tobacco, and get your counseling through a Medicare-participating healthcare provider, you can qualify for this coverage at no out-of-pocket cost. 

Part B also covers an annual low-dose computed tomography (CT scan) to screen for lung cancer. To qualify, you must meet all the following criteria: 

  • You are between 50 and 77.
  • You are asymptomatic of lung cancer.
  • You smoke now, or you quit within the last 15 years.
  • You have a history of smoking 20 cigarettes minimum average per day over 20 years.
  • Your physician has ordered the screening.

There is no cost to you if you use a Medicare-participating healthcare provider. If you are a Medicare Advantage member, check your plan’s directory for a network provider.

Understanding cancer risk

The American Cancer Society analyzes the results of multiple national surveys to understand adult behaviors that increase cancer risk and improve early cancer detection. Live support is available through the National Network of Tobacco Cessation Quitline at 1-800-784-8669. The TTY line is 1-800-332-8615.

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