What Drugs Are Covered By Part D Plans?

By Medicare Benefits - September 8, 2020

Medications are prescribed for all types of medical conditions these days. Many Medicare recipients depend on prescription medications to reduce or eliminate the symptoms of various conditions. Unfortunately, prescription medications can be costly without insurance. Medicare recipients can save money on prescription drugs by enrolling in Part D. Prescription drug coverage does have limitations, however, so it’s important to understand what is and is not included in Medicare Part D.

Medications covered by Part D plans
Medicare Part D covers a wide variety of prescription drugs, but there are some limitations and exceptions. In order to know whether a drug is covered by your plan, you will need to check your plan’s formulary. A formulary lists all drugs that are included in a particular plan’s coverage. Even though there are standards set by the federal Medicare program, your plan may include or exclude specific medications. You’ll want to discuss your options with your physician, if possible before having a prescription written. An alternative medication may be available that addresses your condition and works within your plan’s formulary.

What drugs are not covered?
If you find that no suitable alternative exists and the drug you are prescribed is not included in your plan’s formulary, you can file for an exemption with Medicare. This is usually done through your physician’s office, but you can also contact your plan manager or local Medicare office to learn more. You will need to provide a valid reason for needing an exemption, and if approved, you may still have limitations on coverage of your exempted medications.

Does Medicare Part D cover medications administered in a doctor’s office?
Although most prescription medications are purchased from a pharmacy and self-administered at home, there are scenarios in which you may be given a medication outside of the home. A doctor may administer medication in his or her office to monitor its effectiveness or a medication could be used during an inpatient hospital stay. In these cases, Medicare Part D would usually not cover the cost of the medications. Instead, Medicare Parts A and/or B would apply. Medicare Part A provides coverage for care while in a hospital or skilled nursing facility, and Medicare Part B covers the cost of outpatient care administered in a doctor’s office or at a clinic.

Are supplements covered?
Part D prescription drug coverage does not usually include supplements and over-the-counter medications. This means that you will be required to cover the full cost of these items, and you will also be ineligible to file a claim for purchases.

If, however, you have a Medicare Advantage plan, you may be entitled to additional benefits that are not included in Original Medicare. These benefits may help you pay for supplements or provide reimbursement for purchases of some over-the-counter medications. To be sure that any medication you take is covered, you will need to refer to your plan’s formulary or speak with your Medicare plan manager.

Comparing drug plans

Prescription drug coverage was not originally included in the Medicare program when it was introduced in 1965, but as of 2006, coverage for self-administered drugs is available to Medicare recipients under Part D coverage. This optional coverage provides a benefit for individuals who frequently need medications or who have chronic conditions that require routine treatment through the use of prescription drugs. Review and compare the drug plans available in your area to find the one that meets your individual needs.

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