Drugs and Drug Categories Not Covered by Medicare
Medicare will not allow certain drugs or drug categories to be covered by Part D plans. The excluded drugs and drug classes are:
- drugs used for weight loss, weight gain or anorexia
- drugs used for fertility
- drugs used for cosmetic purposes or hair growth
- drugs used for relief of cough or colds
- drugs for erectile dysfunction, such as Viagra, Cialis or Levitra, unless used to treat other approved conditions
- prescription vitamins and mineral products except prenatal vitamins and fluoride preparations
- barbiturates, such as phenobarbital
- benzodiazepines, such as Valium
- non-prescription drugs available over the counter
- drugs which the manufacturer requires as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee
Other drugs that are not covered by the Part D plan include:
- drugs you receive while in the hospital or medical facility (in most cases )
- compounded drugs unless one component is on the formulary
You can continue to get a Medicare-excluded drug at a retail pharmacy, but it is not covered by your Part D plan. You will have to pay the entire cost for the drug, and the cost will not be applied to your deductible or your true out-of-pocket (TrOOP) total.
The coverage determination and appeals processes do not apply to these drugs. Also, these drugs are not covered for a transitional or emergency fill through your Part D plan.