What Drugs Medicare Part D will NOT Cover

what part D does not cover

Part D is prescription drug coverage administered through a private insurance company. You can either get Part D through a private Medicare Part D plan, or through a Medicare Advantage plan.

Like all parts of Medicare, there are certain things that it just won’t cover. According to national Medicare guidelines, these drugs are never covered under Medicare Part D:

  • Drugs for anorexia, weight loss, or weight gain (except to treat physical wasting)
  • Drugs for fertility
  • Drugs for hair growth or cosmetic purposes
  • Drugs for cough and cold symptoms
  • Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)
  • Non-prescription drugs
  • Drugs for sexual dysfunction like Viagra and Cialis
  • Non-FDA-approved drugs
  • Drugs the FDA has determined to be safe but not effective – evaluated by the FDA’s Drug Efficacy Study Implementation (DESI)
  • Bulk chemicals
  • Devices like diaphragms
  • Ingredient/adjuvant, like sterile water for injection
  • Line flush, like normal saline IV flush
  • Medical supplies
  • Drugs covered by Medicare Part A or Part B

Some of the drugs listed above may be covered by Part D if they are prescribed to treat other conditions, as long as they have been approved by the FDA for that treatment.

Drugs Covered by Parts A and B

Some drugs are covered by Part A or B in special circumstances. Part A will cover drugs needed during a hospital or skilled nursing facility stay. Part B covers some prescription drugs in limited circumstances, such as oral cancer drugs you are given in a doctor’s office or hospital.

What is the Prescription Drug Formulary?

Prescription drugs are listed in a formulary of which drugs are covered by insurance each year, and categorized in different Tiers based on how much you will have to pay. Tier 1 is usually for generics and has the lowest cost-sharing amounts. Tiers 2-5 contain brand-name and specialty drugs, which generally have higher out-of-pocket cost-sharing amounts.

You can search drugs in the 2018 drug formulary here. To get the most accurate information, check your plan’s specific formulary. The National Council on Aging offers more details on what is and isn’t covered under Part D.

Related Links

What is Part D, and Do I Need It?

Medicare Part D Premiums to Decrease

Medicare Part D: Healthcare’s Current Silver Lining

Understanding the Medicare Donut Hole


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