What Doesn’t Medicare Part D Cover

What Doesn’t Medicare Part D Cover?

Medicare Part D is prescription drug coverage, provided by private insurance companies licensed by the federal government. There are certain kinds of drugs that are excluded from coverage, however. Medicare coverage does not include the following:

• Drugs used to treat anorexia, weight loss, or weight gain

  • Note: Part D may cover drugs used to treat physical wasting caused by AIDS, cancer, or other diseases

• Fertility drugs

• Drugs used for cosmetic purposes or hair growth

  • Note: Drugs used for the treatment of psoriasis, acne, rosacea, or vitiligo are not considered cosmetic drugs and may be covered under Part D

• Drugs that are only for the relief of cold or cough symptoms

• Drugs used to treat erectile dysfunction

• Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)

• Non-prescription drugs (over-the-counter drugs)

How to Access Medicare Part D Coverage:

In order to avoid additional medical expenses, it is a good idea to work with your doctor and pharmacy to ensure that what they are prescribing you is covered under your private prescription drug coverage. The following are some ways to ensure this coverage:

• Before you go to the pharmacy, find out if your drug is on your plan’s formulary. If possible, ask your doctor to check that your prescription is covered. Otherwise, call your plan directly or check your plan’s website.

• Find out whether your plan places any restrictions on coverage, such as:

  • Prior authorization: you must get prior approval from the plan before it will cover a specific drug

  • Step therapy: your plan requires you try a different or less expensive drug first

  • Quantity limits: your plan only covers a certain amount of a drug over a certain period of time, such as 30 pills per month

• Use a preferred, in-network pharmacy to fill your prescriptions. Many pharmacy networks include both preferred and non-preferred pharmacies. You typically pay less for your prescriptions at preferred pharmacies.

These steps will help you avoid gaps in coverage and unexpected fees and costs from prescriptions that are not covered by Medicare Part D.

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