You might take a medication that your Medicare Part D Plan does not cover (but others plans do) unless you prove it is medically necessary. You may need to work with your doctor to prove you need that medication or to find a suitable alternative medication, or you may need to change to a Medicare Part D Plan that covers the medication.
You might take a medication that is not covered by Medicare Part D at all, or is not covered for your diagnosis. That means no Medicare Part D Plan will cover it, even if you prove it is medically necessary.
Among the medications not covered by Medicare Part D at all are the "excluded" drugs, including:
- Drugs used for anorexia, weight loss or weight gain. However, Medicare Part D does cover prescription drugs used for AIDS wasting and cachexia.
- Over-the-counter drugs.
- Drugs to relieve cough/cold symptoms. However, cough and cold medicines may be covered if used for purposes other than symptomatic relief, for example a cough medication used to treat a medical condition that causes a cough.
- Fertility drugs.
- Most prescription vitamins, including vitamin D2 and D3, and minerals. Medicare Part D does cover prenatal vitamins, fluoride and vitamin D analogs, such as calcitriol, doxercalciferol and paricalcitol.
- Prescription drugs used for cosmetic purposes or hair growth, but Medicare Part D does cover prescription drugs to treat psoriasis, acne, rosacea and vitiligo.
- Drugs that must be monitored by testing services that only the manufacturer provides, such as certain anti-psychotics.
- Drugs used to treat erectile dysfunction. These drugs may be covered by Medicare Part D if used to treat other conditions, such as pulmonary hypertension.
|NOTE: If you are a member of MaineCare, the Medicare Savings Program, or the Drugs for the Elderly program (DEL), those programs may pay for some of the drugs listed above. Be sure your pharmacist knows you are in MaineCare, the Medicare Savings program and/or DEL.|
In addition, some medications are covered by Medicare Part B, and not covered by Medicare Part D or only covered by Medicare Part D in some situations. In those cases, your pharmacist should bill Medicare Part B.
To find out which Medicare Part D plan's formulary will best meet your prescription needs, go to the Medicare website Formulary Finder,
|NOTE: If you cannot find a plan that covers all of your drugs, you may be able to enroll in a plan and request an "Exception" (Coverage Determination) to obtain full coverage.|
For more information, see our Exceptions (Coverage Determination) page