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What medications (drugs) are covered by Medicare Part D?

Medicare is a government insurance program that’s broken down into four parts, with each part offering different coverage.  Medicare Part A offers coverage for hospital care, Part B gives you medical coverage, Part C (sometimes called Medicare Advantage) is an alternative to Part A and B, and Part D gives you coverage for prescription drugs.

Even though it’s optional, many Americans choose to purchase some prescription drug coverage.  In 2018, 58% of Americans were enrolled in a Medicare Part D plan.

What is Medicare Part D?

Medicare Part D, also sometimes called the Prescription Drug Plan (PDP), was proposed as part of the Medicare Modernization Act and came into effect at the start of 2006.  It’s an optional stand-alone plan that provides an outpatient prescription drug benefit.

In layman’s terms, it helps cover the costs of prescription drugs taken outside of a hospital.  Any medication taken at a hospital would be covered by Part A and each Part D plan will have its own list of covered drugs called the Part D formulary.

We recommend that you enroll in Medicare Part D if you take medications.

What medications (drugs) does Medicare Part D not cover?

In general, Part D excludes drugs not approved by the Food and Drug Administration, drugs prescribed for off-label use, drugs covered under Part B, or drugs not available via prescription in the United States.

While coverage varies, some commonly excluded drugs include:

  • • Drugs for weight loss or weight gain
  • • Fertility or erectile dysfunction drugs
  • • Drugs used for cosmetic purposes
  • • Vitamin and mineral supplements (prenatal vitamins are covered)
  • • Cough and cold medication or other over-the-counter drugs

One thing to be aware of is that even if a drug isn’t covered by your plan, you can usually request a formulary exception if your doctor believes it’s medically necessary for you to take the drug.

Need more information?

So you have a rough idea of benefits, the Kaiser Family Foundation has put together a handy graphic showing Medicare Part D’s Standard Benefit Design for 2019.  But the specific drugs covered by each Part D plan will vary.  If you’re taking medications, you’ll want to make sure that the plan will cover what you’re taking.

If you’d rather not try to figure this out on your own or could use some guidance, speak to a Licensed Medicare Agent at Medicare2019.com by calling 1-844-374-1950 today.  We’ll be happy to break down your options for you and make sure you have the right coverage.