Are both Fioricet with Codeine and plain Fioricet covered under any Medicare Part D prescription drug plan?
Coverage of specific drugs · updated Jun 5, 2025
In comparison, a few 2023 Medicare Advantage plans covered Fioricet with Codeine and Fioricet without Codeine; however, no 2023 stand-alone Medicare Part D plans cover Fioricet with or without Codeine.
For example, the 2023 Network PlatinumChoice (PPO) in Wisconsin covers Fioricet as a Tier 4 Non-Preferred Drug. See: FIORICET 50-300-40 MG CAPSULE and Fioricet/Codeine 50-300-40-30 CAPSULE
A bit of history...
In the 2006 "Part D Drugs/Part D Excluded Drugs" document, Medicare noted that Fioricet® (Bultalbital, APAP, Caffeine) may not be covered under the basic Medicare Part D benefit (when used for “medically accepted indication” and not covered under Medicare Parts A or B) ("Medically Accepted Indication" for purposes of Part D is an FDA labeled indication or an indication supported by citation in either the American Hospital Formulary System (AHFS), USP-DI, or Drugdex.)
Fioricet without Codeine contains Butalbital which is a barbituate and barbituates are one of the classes of drugs which are excluded by the Medicare Part D program by law. (You can see the full list of excluded Medicare Part D drugs at on this site.)
The same 2006 Medicare document notes that Fioricet® with Codeine may be covered by Medicare Part D plans.
However, please note: As of January 1, 2013, Medicare Part D prescription drug plans must provide coverage of Barbiturates "when used to treat epilepsy, cancer, or a chronic mental health disorder" and Benzodiazepines. (see Section 175 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)).
In 2018, a few stand-alone Medicare Part D plans and a number of Medicare Advantage plans in counties around the county cover both forms of this drug:
As an example, you can use our Drug Finder to see the Medicare Advantage plans in Summit County, Ohio that cover Fioricet (with and without Codeine)
on this site
and
on this site
You can change the ZIP Code to see if there is any Medicare plan coverage for these medications in your area.
(source as of 02/26/2016): https://www.cms.gov/ Medicare/ Prescription-Drug-Coverage/ PrescriptionDrugCovContra/ downloads/ PartDDrugsPartDExcludedDrugs.pdf)