Does Medicare cover Symbicort in North Carolina?

What Symbicort is used for

Symbicort is an inhaler that combines an inhaled corticosteroid (budesonide) and a long-acting bronchodilator (formoterol). Its FDA label covers asthma in people 6 and older and maintenance treatment of COPD.

This page explains Medicare coverage only. Questions about whether Symbicort is right for you belong with your prescriber.

Which part of Medicare covers Symbicort

Symbicort is a handheld inhaler, so it's a Part D drug. Medicare's drug-coverage booklet lists drugs used with some durable medical equipment, like a nebulizer, under Part B, but that doesn't apply to Symbicort. Your rescue inhaler is a separate prescription and a separate formulary entry, so check both when you compare plans.

Is Symbicort on Medicare's negotiated-price list?

No. Symbicort is not among the drugs CMS has selected for the Medicare Drug Price Negotiation Program so far: the 10 drugs with negotiated prices since January 1, 2026, the 15 with negotiated prices starting January 1, 2027, and the 15 CMS selected on January 27, 2026, for prices that take effect in 2028. The program selects only drugs without generic competition, and Symbicort has one.

Generics

FDA approved Breyna (budesonide and formoterol fumarate dihydrate inhalation aerosol) as the first generic of Symbicort in March 2022. In North Carolina, G.S. 90-85.28 lets a pharmacist fill a prescription written for Symbicort with an equivalent generic when it costs you less, unless your prescriber signs "Dispense as Written" or says so when calling it in. Inhaler generics can look and feel slightly different from the brand, so ask your pharmacist to show you the device if your plan or pharmacy switches you.

What you pay for Symbicort in 2027: the out-of-pocket cap

Your cost depends on your plan: its deductible, the tier it puts the brand and the generic on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:

• 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
• The maximum Part D deductible for 2027 is $700. No plan can set a higher one.
• Only covered drugs count. If your plan doesn't cover the version you use and you pay cash or use a discount card, that spending doesn't count toward the cap.

Spreading the cost: the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of at the pharmacy. Every Part D plan and Medicare Advantage plan with drug coverage offers it. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. More in What is the Medicare Prescription Payment Plan?

Extra Help with Symbicort

Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic, like Breyna, and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have full NC Medicaid, a Medicare Savings Program (North Carolina calls them MQB) or SSI. Otherwise, apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213 (TTY 1-800-325-0778). North Carolina has no general state drug-assistance program for seniors. See Extra Help in North Carolina.

Getting Symbicort covered in North Carolina

North Carolina is a Part D region of its own (PDP Region 08), so each standalone Part D plan sold here is offered in all 100 counties. For 2027, CMS lists 11 standalone Part D plans from 6 companies in the state, and every county has Medicare Advantage plans open to everyone, from 11 in Carteret County to 57 in Guilford County. Each plan has its own formulary. Your county's numbers are on North Carolina counties.

Storms and evacuations. CMS says Medicare pays to replace prescription drugs that are lost, destroyed or damaged in a disaster; call your plan first, and 1-800-MEDICARE if you can't reach it. Pack both your controller and rescue inhalers when you evacuate. See early refills before a hurricane.

State Health Plan retirees. If you're in the State Health Plan's Base Plan or Enhanced Plan (group Medicare Advantage plans with Part D), Symbicort or its generic is covered, or not, under the Plan's drug list. The Plan says joining an outside Part D or Medicare Advantage plan disenrolls you from its group plan and moves you to the 70/30 Plan. See State Health Plan retirees and Medicare.

Medicare and NC Medicaid. If you have both, Medicare drug coverage, not NC Medicaid, pays for Part D drugs like Symbicort. If your Medicare Advantage plan ends in 2027, you have a special enrollment period through February 28, 2027; choose new drug coverage by December 31, 2026, to avoid a gap. See plans ending in 2027.

How to check whether a plan covers Symbicort

1. Write down the exact drug. Brand or generic, the strength and how many puffs a day, plus your rescue inhaler.
2. Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Symbicort or its generic and any rules.
3. Read the rules next to the drug. Quantity limits are common for inhalers; if you need more, your prescriber can ask for an exception.
4. Check your 2027 notice. Your plan's Annual Notice of Change says whether the brand or generic stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026.
5. Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

If your plan doesn't cover the version you need, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if waiting could seriously harm your health. See How do I appeal a Medicare denial in North Carolina?

Sources

• National Library of Medicine — DailyMed: Symbicort prescribing information (FDA label)
• Medicare.gov — Drug coverage (Part D)
• Medicare.gov — Your Guide to Medicare Drug Coverage (CMS Product 11109)
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
• CMS — Selected drugs for initial price applicability year 2028 (fact sheet, January 2026)
• FDA — Orange Book: approved drug products and therapeutic equivalents (budesonide and formoterol fumarate dihydrate)
• North Carolina General Statutes — G.S. 90-85.28, selection of equivalent drugs by pharmacists
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold, deductible and Extra Help copays)
• Medicare.gov — Medicare Prescription Payment Plan
• Social Security — Extra Help with Medicare prescription drug plan costs
• eCFR — 42 CFR 423.120 (formularies and transition fills)
• CMS — Prescription drug coverage (CY 2027 Landscape files: North Carolina is PDP Region 08)
• CMS — Replacing Durable Medical Equipment and Prescription Drugs after a Disaster
• State Health Plan — Retiree presentation (group Medicare Advantage and outside Medicare plans)

Frequently asked questions

Medicare in your North Carolina county

Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →