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Sulfamethoxazole/trimethoprim Medicare coverage

Generic Bactrim and Septra and Sulfatrim

Used for Diarrhea, Ear Infection

Sulfamethoxazole/Trimethoprim Coupon - Sulfamethoxazole/Trimethoprim 800mg/160mg tablet

Sulfamethoxazole/trimethoprim (sometimes known as SMZ/TMP) is a combination medication containing an antifolate and sulfa antibiotic. It's used to treat different types of infections, such as urinary tract infections (UTIs), ear infections, and lung infections. This antibiotic has two different brand names, Bactrim and Septra, and it's also available as a lower-cost generic. It's a tablet that's taken by mouth, typically twice daily for most types of infections. This antibiotic also comes as a suspension under the brand name Sulfatrim for people who can't swallow tablets and as an injection for people in the hospital. Common side effects include nausea, diarrhea, and rash.

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Medicare: Your GoodRx guide

Learn the ins and outs of Medicare with our comprehensive guide that covers eligibility, coverage, costs, and more.

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Common Medicare glossary terms
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Annual Notice of Change (ANOC):

The Medicare Annual Notice of Change (ANOC) is a letter for people enrolled in Medicare Advantage plans and anyone with Medicare Part D prescription coverage. People with Medicare Advantage or original Medicare (Part A and/or Part B) can have Part D plans. The ANOC informs enrollees about any changes to their benefits for the coming coverage year. By law, Medicare Advantage and Part D plans must send the ANOC to enrollees by September 30 — which is before the annual Medicare open enrollment period of October 15 to December 7. Even if you have the same plan, your benefits could change year to year.

Premium:

A premium is the cost of having a health insurance plan and is usually paid monthly. Medicare enrollees may pay several premiums. Most people don’t pay anything for Part A hospital insurance, but some people do depending on how long they worked and paid taxes. For outpatient and preventive coverage, the Part B standard premium is $185 a month in 2025, but people with higher incomes pay more. Your premium for Medicare Advantage plans will vary, but even so-called “zero premium” plans require you to pay your Part B premium. Part D premiums range in price, but the average is about $47 a month in 2025. If you have original Medicare and a Medigap supplement plan, you have an additional premium for that coverage.

Deductible:

A deductible is the amount you pay out of pocket before your Medicare plan begins cost-sharing. In 2025, the Part A deductible is $1,676 per benefit period. The Part B deductible is $257 for the year, but you can access certain preventive care — including some vaccines — without meeting your deductible. Medicare Advantage deductibles vary and your Part D deductible can’t exceed $590 in 2025.

Out-of-pocket limit:

Original Medicare has no annual out-of-pocket maximum. Medicare Advantage plans have out-of-pocket limits. In 2025, they are $9,350 for in-network covered services and $14,000 for in-network and out-of-network covered services combined.

Medicare Prescription Payment Plan:

Starting January 1, 2025, anyone with Part D coverage had the option to use the Medicare Prescription Payment Plan for their out-of-pocket medication costs instead of paying upfront at the pharmacy. This plan doesn’t provide savings, but allows you to spread prescription costs — including your deductible — over the year. Making payments can be particularly helpful for people who may skip or delay picking up prescriptions because of high costs early in the year. Also in 2025, the Part D out-of-pocket limit dropped to $2,000.

Initial coverage phase:

After a Medicare enrollee meets the Part D deductible (if the plan has one), the health insurance begins cost sharing. The initial coverage phase means you pay coinsurance or a copay for covered prescriptions.

Catastrophic phase:

When you reach the $2,000 out-of-pocket maximum, your Part D plan pays for 100% of covered medications for the rest of the year.

Medication ready
How to save on drugs with Medicare

Medicare Part D is the part of Medicare that helps cover prescription medications, including both brand name and generic. It also includes coverage for certain vaccines that aren’t covered by Part B, as well as some medical supplies.

Even with Medicare Part D coverage, you may still have out-of-pocket costs such as premiums, deductibles, copayments, and coinsurance. As of 2025, Medicare Part D plans include a $2,000 annual out-of-pocket cap. Once you reach this limit, your plan covers the full cost of your covered medications for the rest of the year.

Still, there are several ways to reduce your prescription medication cost. From GoodRx coupons to patient assistance programs, here are ways you can save money on the medications you need.

1. See if you qualify for Medicare’s Extra Help program

The Medicare Extra Help/Low-Income Subsidy program is a federally funded program for people covered under a Medicare Part D plan. It helps reduce enrollees’ out-of-pocket costs by limiting their deductibles and copays. To qualify, your income and assets fall below a certain limit.

If you’re eligible, you may receive:

  • No monthly premiums for Medicare Part D

  • No Medicare Part D deductible

  • Low copays for prescription medications

2. Use GoodRx coupons

You can’t combine GoodRx coupons with Medicare, but you can choose to use a coupon instead of your insurance if it results in a lower price.

Here’s how to download a GoodRx coupon:

  1. Go to the GoodRx website, or download the GoodRx app on your phone.

  2. Search for your prescription medication.

  3. Enter your prescribed dose and quantity, then set your location.

  4. Compare prices across different pharmacies in your area.

  5. Click “Find the lowest prices” or press “Enter.”

  6. You can have the coupon sent by text or email, or print it out.

  7. To apply the discount, show the coupon at the pharmacy when you fill your prescription. Ideally, this is done at drop-off before the prescription is filled.

3. Consider the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new program that can help make paying for medications more manageable. It’s open to anyone with a standalone Part D plan or those with Medicare Advantage plans that offer prescription medication coverage.

There is no cost to participate in the Medicare Prescription Payment Plan and participation is voluntary. Instead of paying for the total cost of your medications up front at the pharmacy, the payment plan allows you to spread the cost into smaller payments during the year. If you join, you will continue to pay your premium every month as well as an additional monthly amount on your payment plan. It’s a good idea to review how the Medicare Prescription Payment Plan works to determine if it’s right for you.

4. Compare Part D plans during open enrollment

Medicare open enrollment, which takes place every year from October 15 to December 7, is your chance to switch plans if another option offers better prescription medication coverage or lower costs. Plan costs and coverage details can change each year, so it’s important to review your options.

Here are some steps to help you compare plans:

  1. Make a list of all your medications and what dosages you take.

  2. Enter the names of your prescription medications to see which plans offer the best coverage.

  3. Look at premiums, deductibles, and medication costs for each plan. Plans usually change their formularies, premiums, and copays annually.

  4. Check if your preferred pharmacy is in each plan's network.

5. Get a 90-day supply

Opting for a 90-day supply instead of a monthly refill of your medication might help reduce your long-term out-of-pocket costs. Many insurance plans offer lower copays or bulk pricing for 3-month prescriptions.

If your medication is covered under your plan, see if your insurer’s mail-order or specialty pharmacy provides savings on a 90-day supply. If they do, ask your prescriber to write a prescription for a 90-day quantity to take advantage of these potential savings.

6. Ask about the generic version of your medication

Some medications have a generic version, and they generally cost less than the brand-name prescriptions. Generic medications are just as safe and effective as brand-name medications, so it’s an option worth considering to reduce your cost. Ask your prescriber about switching to a generic version of your medication to save money.

7. Consider lower-cost alternative medications

There may be other medications that help manage your condition, and they may cost less. If your medication is costly or not covered by your insurance, talk to your prescriber about lower-cost alternatives that might be a good option for you. Alternatives might have better insurance coverage or lower costs.

8. Learn more about patient assistance programs

Patient assistance programs (PAPs) offer free or low-cost medications to uninsured and low-income consumers. These programs, which primarily offer savings on brand-name medications, are usually run by private pharmaceutical companies or nonprofit organizations. You must meet certain qualifications and complete paperwork to receive savings from PAPs. However, some PAPs exclude Medicare recipients, so it’s important to review the program’s rules and requirements carefully.

9. Check state-funded resources

Depending on where you live, your state may offer programs to help you navigate prescription medication costs. A good place to start is your local Department of Aging. This U.S. Department of Health and Human Services office can help you find the best Medicare plan for the coverage you need.

Some states even have their own cost-saving programs for older adults. For example, Pennsylvania runs PACE and PACENET. These programs help eligible residents get prescription medications at reduced costs.

Alternatively, you can find out if your state has a State Pharmaceutical Assistance Program by using Medicare’s search tool. These programs are state-run and help qualifying residents pay for prescription medications.

10. Use a health savings account to pay for prescription medications

Although you can’t contribute to a health savings account (HSA) after enrolling in Medicare, you can still use any remaining funds in your account to pay for qualified medical expenses. An HSA allows you to use tax-free dollars to pay for eligible prescription medications. The money in your account does not expire so you can use your funds at any time to reduce your out-of-pocket medication costs.

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Frequently asked questions about Sulfamethoxazole/trimethoprim

It's not completely clear how long side effects from Sulfamethoxazole/trimethoprim will last. It generally depends on the specific side effect, but most tend to go away once you stop taking the medication. In the meantime, there are some things you can do to help prevent or ease certain side effects. For example, taking the antibiotic with food might help with nausea, but be sure to avoid greasy and spicy foods. You can also try eating smaller meals throughout the day. Drink plenty of fluids if you have diarrhea as a side effect to prevent dehydration. This antibiotic can also make your skin more sensitive to light, so it's best to wear sunscreen to prevent sunburns. Ask a healthcare professional if you're having bothersome side effects from Sulfamethoxazole/trimethoprim and you need tips on how to manage them.

It depends on how severe your urinary tract infection (UTI) is. Sulfamethoxazole/trimethoprim is typically prescribed for 3 days for a mild UTI. But a more severe UTI, such as a UTI with a fever, requires antibiotic treatment for up to 2 weeks. Your prescriber will decide how long you should take Sulfamethoxazole/trimethoprim for. It's important to take the entire treatment course that you're prescribed to make sure your infection goes away completely.

Tiredness isn't a common side effect of Sulfamethoxazole/trimethoprim, but it's possible. Also keep in mind that it's normal for your body to feel a little tired while it's fighting off an infection. But it's recommended to contact a healthcare professional right away if you notice severe fatigue after you start taking Sulfamethoxazole/trimethoprim. This can be symptom of electrolyte changes from antibiotic treatment, and it should be treated right away.

In general, Sulfamethoxazole/trimethoprim starts to work quickly, but it also depends on what infection you have and how serious it is. For example, you should start to feel better as soon as 2 to 3 days after starting the antibiotic for a urinary tract infection (UTI). But it can take a few weeks to feel better if you have a more serious infection, like pneumonia. Even if you start feel better, it's important to take Sulfamethoxazole/trimethoprim exactly as prescribed and finish your treatment course. Stopping the antibiotic earlier than prescribed can make your infection come back and be harder to treat.

Yes, sulfamethoxazole is a sulfa drug. This means that Sulfamethoxazole/trimethoprim might not be a safe choice for you if you have a sulfa allergy. Your prescriber will decide to use this antibiotic to treat your infection based on what your reaction to sulfa was like. You still might get prescribed Sulfamethoxazole/trimethoprim if you had a mild rash or itchy skin when you took a medication with a sulfa ingredient; make sure to watch closely for allergic reactions when you take Sulfamethoxazole/trimethoprim. But your prescriber might choose to use a different antibiotic to be safe if you had a severe reaction like facial swelling, closing of the throat, or anaphylaxis.

No, Sulfamethoxazole/trimethoprim isn't a penicillin. It belongs to a different class of antibiotics. This means that you can safely take Sulfamethoxazole/trimethoprim if you have a penicillin allergy.

The only medication that you shouldn't take with Sulfamethoxazole/trimethoprim is dofetilide (Tikosyn). This is because the antibiotic can raise the levels of dofetilide (Tikosyn) in the body, which can raise the risk for dangerous side effects like abnormal heart rhythms. Keep in mind that there are other medications that interact with Sulfamethoxazole/trimethoprim. But you can typically still take them with the antibiotic, as long as the dosage of your medications is adjusted or as long as your healthcare team is following up with you more often. Make sure to tell your prescriber and pharmacist about all of the medications you're taking. They can check for drug interactions with Sulfamethoxazole/trimethoprim.

It's best to avoid alcohol while you're taking Sulfamethoxazole/trimethoprim. Wait at least 2 days after you finish your treatment before you reach for an alcoholic beverage to enjoy. Alcohol can worsen side effects from the antibiotic, like diarrhea, nausea, and vomiting. Though unclear, it's also possible that drinking alcohol with this antibiotic can lead to a disulfiram-like reaction, which could cause severe nausea and vomiting, shortness or breath, headache, and irregular heartbeat. Finally, alcohol can make it harder for you to recover from an infection. Speak with a healthcare professional about your drinking habits and ways to avoid alcohol while you're taking Sulfamethoxazole/trimethoprim.