What Prescription Drugs Are Covered Under Medicare Part D?

Tips for understanding what prescription drugs are covered under Medicare Part D, and strategies that may help you still receive coverage for a drug not on the formulary list.

While some prescription drugs are covered under Medicare Part B, the majority of the drug coverage one likely will need will be through Medicare Part D. Unlike Medicare Parts A and B, Medicare Part D must be purchased through a private health insurance company contracted with the government. Prescription drugs covered under Medicare Part D include outpatient prescription medications that are included on the plan’s formulary list, and purchased from a pharmacy in the network.

Medicare Part D’s Formulary List

A formulary list is a list of approved prescription drugs covered under Medicare Part D. If the prescription drug you need is not on the formulary list, the prescribing physician may be able to have an exception made, provided the drug in question is not one of the drugs excluded by law from Medicare Coverage.

Drugs Excluded by Law from Medicare Coverage

•Over-the-counter drugs that do not require a prescription
•Fertility drugs
•Cosmetic drugs
•Some anti-anxiety drugs
•Vitamins or minerals, except in the case of pre-natal vitamins or fluoride preparations.
•Drugs used for weight gain or loss, except in the case of weight loss caused by disease.
•Drugs for Anorexia
•Drugs used to relieve the symptoms of a cold.

While Medicare Part D may exclude these drugs from coverage by law, they may still be covered to treat other conditions, as long as the Food and Drug Administration approves the use of that particular drug for said condition.

Asking for exceptions

Anytime Medicare denies coverage of a particular prescription drug, you are entitled to make a request for an exception. This request must be made with the assistance of the prescribing physician.

Related posts

1. Are Prescription Drugs Covered By Medicare?
2. What Does Medicare Part D Pay For?
3. What Drugs Do Medicare Part D Plans Cover?
4. How Much Should I Pay For Prescription Drugs While on Medicare With Plan D?
5. Medicare Part D, How Does It Work?

Send this page to a friend ...

Enter friend's email address
.