Medicare Treatment for Eczema: Insurance Coverage, Expenses, and Additional Information
In 2025, managing eczema, a common skin condition that can cause itchy, dry skin, may come with significant costs for those on Medicare. Here's a breakdown of what you need to know.
Eczema Treatments and Their Costs
Crisaborole (Eucrisa), a topical ointment that can reduce eczema symptoms, may cause stinging or burning upon application. The monthly Part B premium for this treatment is approximately $185 or more, depending on income, with a $257 annual deductible.
Topical corticosteroids, such as hydrocortisone, are commonly used to reduce itching and inflammation. However, they can cause side effects like thinning of the skin and cataracts.
For more severe cases, biologic drugs like Dupilumab (Dupixent) and Tralokinumab-ldrm (Adbry) may be prescribed. These treatments, while effective, can come with side effects such as injection site reactions, pinkeye, and cold sores on the mouth. The cost of these medications can be high, often thousands of dollars per month.
Medicare Coverage
Medicare covers medically necessary treatment for eczema, including topical, oral, and injection medications, and phototherapy. However, Part B only covers a standard 20% coinsurance for these treatments, with the majority of costs falling under Part D or Medicare Advantage drug benefits.
Medicare Advantage and Part D Plans
The average out-of-pocket costs for eczema treatments under Medicare Advantage and Part D plans in 2025 vary widely. Factors such as the specific medication prescribed, the plan's cost-sharing structure, and whether specialty drugs are involved can significantly impact costs.
Specialty eczema drugs, like biologics, can cost thousands per month, and patients may pay a percentage coinsurance in the specialty tier, potentially resulting in several hundred to over a thousand dollars monthly out-of-pocket without additional assistance.
Extra Help and Manufacturer Assistance
Extra Help provides assistance in paying Part D costs for people with limited income and resources, and it can help with the cost of eczema treatments. Additionally, some manufacturers offer copay assistance programs for specialty eczema medications.
Navigating Costs
To get a precise estimate of expected costs for 2025, it is recommended to review the specific Medicare Advantage or Part D plan formulary and cost-sharing information, consult with the prescribing dermatologist and pharmacist about plan coverage and prior authorization requirements, and explore eligibility for Extra Help or manufacturer copay assistance programs.
In conclusion, while the costs of eczema treatments under Medicare have surged, average out-of-pocket expenses vary widely, often ranging from moderate copays for generic/topical treatments to hundreds or thousands of dollars for specialty biologics, depending on plan design and patient assistance eligibility.
- Seekers of eczema treatments in 2025, particularly for severe cases, might be prescribed biologic drugs like Dupilumab or Tralokinumab, which are effective but often come with high costs, sometimes thousands of dollars per month.
- For those on Medicare Advantage or Part D plans, average out-of-pocket costs for eczema treatments can significantly vary, with factors such as medication specificity and plan cost-sharing structure playing a significant role.
- Extra Help, a program designed to aid people with limited income and resources, can assist in paying Part D costs and help manage the costs of eczema treatments.
- Ads for copay assistance programs might be seen from manufacturers of specialty eczema medications, providing more financial relief for persons diagnosed with eczema.
- Persons diagnosed with eczema, often referred to as 'switchers' due to their need to switch treatments based on effectiveness and cost, should consider exploring eligibility for Extra Help or manufacturer copay assistance programs to better manage their out-of-pocket costs.
- The science behind health-and-wellness, skin-care products, and eczema treatments continues to evolve, with new treatment options, like topical ointments and biologic drugs, offering potential solutions for eczema sufferers, although they may require seeking health insurance coverage or financial assistance.
