What Medicare Part D Covers

Medicare Part D plans cover your prescription medications. Each plan has a list of medications it covers called a formulary. It is broken down into tiers, typically by generic, name brand, and so on.

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What does Medicare Part D cover?

Each Medicare Part D plan has a formulary — a list of medications it covers. Medicare requires the plan must offer at least two drugs in each class. Also, each plan cover all — or nearly all — prescription drugs in these classes:

  • Antidepressants
  • Antipsychotics
  • Anticonvulsants
  • Immunosuppressants
  • Anti-cancer medications
  • HIV/AIDS drugs

Part D plans also cover common vaccines to prevent illness.

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What drugs doesn’t Part D cover?

Prescription drug plans do not cover any medications Original Medicare covers for you. Other than that, there are a few medications that Part D will not typically cover including:

  • Any weight loss or weight gain drugs
  • Fertility medication
  • Over-the-counter medication
  • Erectile dysfunction medication
  • Cosmetic drugs

You may find a Part D carrier that offers these medications, but it is not the norm. Also, the above list is not a complete one. If you do feel you need a drug that is not on a formulary you would like to be on, you have the right to ask for an exception.

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Formularies can change at any time.

It is important to realize that drugs can come and go from the formularies at any time. However, the insurance company must let you know when any changes are coming.

All plans are restricted from making changes to the drugs provided and making price changes between the beginning of the annual election period until 60 days after coverage begins. The only exception is if the FDA determines a drug is unsafe or the manufacturer ceases production
of the drug.

Also, any changes must include the name of the drugs removed, if the drug changes tires, the reason for the change, alternate drugs available, any cost sharing, and exceptions available.

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