Drugs and Drug Categories Not Covered by Medicare
Medicare will not cover certain drugs under Part D. The excluded drugs and drug classes are:
- drugs used for weight loss, weight gain or anorexia
- drugs used for infertility
- drugs used for cosmetic purposes or hair growth
- drugs used for relief of coughs or colds
- drugs for erectile dysfunction, such as Viagra, Levitra or Cialis, unless used to treat other approved conditions
- prescription vitamins and mineral products except prenatal vitamins and fluoride preparations
- drugs you receive while in a hospital or medical facility
- barbiturates, such as phenobarbital
- benzodiazepines, such as Valium
- non-prescription drugs available over-the-counter
- compounded drugs, unless the major component is a Part D drug.
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 decision 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.