Specialty Drug

Sodium Oxybate

SODIUM OXYBATE is used to treat excessive sleepiness and cataplexy in patients with narcolepsy. Cataplexy causes a sudden muscle weakness due to a strong emotional response. This medicine is not available in retail pharmacies. Your doctor will enroll you in a program that will provide the drug to you. Compare central nervous system depressants.

Xyrem Medicare Coverage


Does Medicare cover Xyrem?

100% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Xyrem co-pay with Medicare?

It depends. Which coverage stage are you in? Click on a tab below…

Donut Hole
Post-Donut Hole
Co-Pay Range
$3733 – $4078
In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.
Co-Pay Range
$933 – $1346
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$1668 – $1835
In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year.
Co-Pay Range
$15 – $204
In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare will cover most of your drug costs. In 2016, this stage begins once you have spent $4,850.
Want an exact price for your co-pay?

Ways to Save on Xyrem

Here are some ways that may lower the cost of your Xyrem prescription.

When Will the Generic Be Available?
Some or all forms of Xyrem may become available as generic sodium oxybate after June 2024, depending on FDA approval and patent expiration.

Find Your Xyrem Medicare Co-Pay

Here are average co-pays for some of the most popular Medicare plans. Be sure to add your plan to see your specific co-pay. If a price is shown in red, GoodRx has found discount prices that are lower than your Medicare co-pay.

Average Co-Pay for 1 bottle (180ml) 500mg/ml of Xyrem oral solution

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO)Lower price available $1049
AARP MedicareComplete Plan 1 (HMO)Lower price available $1101
AARP MedicareComplete SecureHorizons (HMO)Lower price available $1016
AARP MedicareRx Preferred (PDP)Lower price available $1227
AARP MedicareRx Saver Plus (PDP)Lower price available $959
Aetna Medicare Rx Saver (PDP)Lower price available $975
Cigna-HealthSpring Preferred (HMO)Lower price available $1181
Cigna-HealthSpring Rx Secure (PDP)Lower price available $942
Cigna-HealthSpring Rx Secure-Extra (PDP)Lower price available $1017
EnvisionRxPlus Silver (PDP)Lower price available $960
Express Scripts Medicare - Value (PDP)Lower price available $972
First Health Part D Value Plus (PDP)Lower price available $1287
Humana Enhanced (PDP)Lower price available $1257
Humana Preferred Rx Plan (PDP)Lower price available $952
Humana Walmart Rx Plan (PDP)Lower price available $952
Kaiser Permanente Senior Advantage (HMO)Lower price available $1285
MedicareBlue Rx Standard (PDP)Lower price available $1013
SilverScript Choice (PDP)Lower price available $1335
Symphonix Value Rx (PDP)Lower price available $962
WellCare Classic (PDP)Lower price available $1017
Don't see your Medicare plan above?

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Xyrem Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Xyrem that may include:

Quantity Limits

Most Medicare plans restrict the amount of this prescription that can be purchased at one time. If you need to purchase a greater amount at one time, it may not be covered. Your options are to wait until that time period has passed before refilling, call your plan and ask for an exception, or consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

Prior Authorization

Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan and they may require you to have your doctor fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

What drug tier is Xyrem typically on?

Tier 5

Medicare plans typically list Xyrem in Tier 5 of their formulary. Tier 5 drugs are usually non-preferred brand-name drugs. Tier 5 drugs cost more than Tier 1, 2, 3 and 4 drugs.

Does your plan have restrictions?

See discount prices that can save you money when your Medicare plan doesn't work for you.

Medicare prices are provided by the Centers for Medicare and Medicaid Services (CMS). If you encounter any issues, please let us know.
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