Does Medicaid cover Trintellix?

In this article:

• Does Medicaid cover Trintellix?
• Factors influencing Medicaid coverage for Trintellix
• How much does Trintellix cost?
• Cost of Trintellix with Medicaid
• How to get Trintellix with Medicaid
• Ways to get discounts on Trintellix without Medicaid

In this article

• Does Medicaid cover Trintellix?
• Factors influencing Medicaid coverage for Trintellix
• How much does Trintellix cost?
• Cost of Trintellix with Medicaid
• How to get Trintellix with Medicaid
• Ways to get discounts on Trintellix without Medicaid

Trintellix (vortioxetine) is a brand-name prescription medication that was approved by the Food and Drug Administration (FDA) in 2013 to treat major depressive disorder (MDD) in adults. It belongs to a class of drugs known as serotonin modulators and stimulators (SMS) that balance serotonin, a substance in the brain that affects mood. As an antidepressant, Trintellix regulates serotonin levels while helping reduce sadness, loss of interest in activities, and difficulties in thinking or concentrating. 

Medicaid is a government program supported by the federal government and the states. It helps people with limited income pay for doctor visits, hospital stays, and prescription drugs. But specific benefits and eligibility criteria vary by state. This includes coverage for Trintellix. 

Does Medicaid cover Trintellix?

The answer is not a simple one. It really depends on your state. Each state has its own Medicaid program and coverage for health services and prescriptions, and the coverage for medications can vary. 

For example, each state has its own Medicaid formulary, which includes a list of medications the program covers. In some states, Trintellix may be part of the formulary, but certain factors may influence whether it is covered and how much Medicaid beneficiaries will be required to pay out of pocket. In addition, in many states, the Medicaid program is administered through private, managed plans. Formularies and restrictions (e.g., step therapy and prior authorization) can and do vary by plan.

Factors influencing Medicaid coverage for Trintellix

If Medicaid covers Trintellix in your state, there may be specific criteria your healthcare provider must meet:

• Diagnosis: In many cases, you must have a confirmed diagnosis of MDD from your healthcare provider or another condition for which Trintellix may be approved. 
• Previous treatments: In some states, Medicaid may require you to try less expensive antidepressants before trying Trintellix. This is known as step therapy. Medicaid may also need proof that other treatments did not work before approving Trintellix.
• Prior authorization: Medicaid may require your healthcare provider to prove that you need Trintellix before it will approve coverage. Your healthcare provider will take care of this process, but it could take a few days to a week for them to submit the required information about your condition and justification of why Trintellix is needed. 
• Income level: Your income level can also affect your Medicaid coverage. States may have specific income requirements that will allow you to get benefits, including coverage for prescription medications like Trintellix.

How much does Trintellix cost?

The average retail price of Trintellix without insurance is $645 for 30, 20 mg tablets. However, the price fluctuates and can vary by pharmacy, dose prescribed, and location—among other factors. It’s a good idea to compare prices at different locations or use price comparison tools to find the best deal. 

Cost of Trintellix with Medicaid

If your Medicaid plan covers Trintellix, the cost will depend on your income level and whether your state’s Medicaid formulary considers Trintellix a preferred drug or a nonpreferred drug. While Medicaid can help lower the cost of medications, there might still be some out-of-pocket expenses:

• Copays: This is a small fee for each prescription. They can range from a few dollars to around $10 if you have Medicaid. According to the drug’s manufacturer, Takeda, Medicaid beneficiaries have copay costs that average $1.05 per month.
• Coinsurance: You may need to pay a percentage of the medication’s cost. This is called coinsurance, and it can vary by state, income level, and medication.
• Monthly premiums: Depending on your income and the state’s Medicaid plan, you may need to pay a monthly fee for your Medicaid coverage.

To determine what you’ll pay, check your State’s Medicaid formulary or speak with your local Medicaid office.

How to get Trintellix with Medicaid

Getting the medication you need can sometimes feel like a puzzle. If you’re using Medicaid and need Trintellix, follow these steps:

1. Talk to your healthcare provider. Start a discussion about how you feel with your healthcare provider. Together, you can determine if Trintellix is the right treatment for you.
2. Wait for Medicaid approval, if required. If Medicaid requires prior authorization, your healthcare provider will start the process. 
3. Fill your prescription. Once you have approval, you can get Trintellix at a local pharmacy.

Ways to get discounts on Trintellix without Medicaid

If Medicaid doesn’t cover Trintellix or you don’t have Medicaid, there are still ways to save on your prescription. For example, a SingleCare prescription discount card offers digital coupons that can help lower the cost of Trintellix at many pharmacies. For example, with a SingleCare coupon for Trintellix, you could pay $425 instead of $645 for a one-month supply.  

RELATED: How to save on Trintellix

Keep in mind that, if you have Medicare and full Medicaid coverage, you are considered dually eligible, meaning you may be able to use Medicaid to pay for certain things that Medicare won’t. Medications may or may not be one of those things. If you struggle to afford Trintellix with Medicare, you can also apply for the Medicaid Part D Low Income Subsidy (LIS) program, also known as Extra Help. If you have both Medicare and Medicaid, you automatically qualify for and are enrolled in Extra Help.

RELATED: Does Medicare cover Trintellix?

Your healthcare provider may also be able to recommend Trintellix alternatives that are either more affordable or are available in generic form.

RELATED: Trintellix vs. Viibryd

Bottom line

Medicaid might cover Trintellix, but specific coverage depends on which state you live in and whether your healthcare provider can prove it is medically necessary. In some states, your income level may also affect how much you pay out of pocket for Trintellix. It’s always important to check with your healthcare provider, pharmacist, and local Medicaid office for the latest information on coverage and costs. Asking these questions can help you find the best treatment you need.