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What Medicare Part D Covers

Prescription drugs covered under the Medicar Part D plan in a plastic case.

Medicare Part D can cover prescription drugs. Each plan will vary and have its drug formulary – the list of medications it provides coverage for and how much these medications will cost.

What does Medicare Part D cover?

Part D plans are required to cover a wide range of prescription drugs. Each plan has a “formulary,” which is the list of prescription drugs that it covers. Each covered medication falls into one of the formulary’s “tiers.” The cost of the drug is dictated by which tier it calls into. The higher the level, the higher the price.

While Part D plans do not offer coverage on all medications, drugs in protected classes must be included. This includes drugs used to treat cancer and HIV/AIDS.

Other protected medications include antidepressants, antipsychotics, immunosuppressants, and anticonvulsive treatments for seizure disorders.

Part D policyholders may request an exception or file an appeal if they need medication not on the formulary.

What drugs doesn’t Part D cover?

Though limited, there are a few prescriptions that Original Medicare covers. Part D will not cover any medications already covered by Original Medicare.

Part D will typically not cover weight loss or gain medications, fertility medications, over-the-counter drugs, cosmetic drugs, or those used to treat erectile dysfunction.

Check your plan’s formulary to be sure of the medications covered under the Part D plan.

English meaning of change, referring to Medicare Part D formularies can change at any time.
Part D formularies can (and often do) change.

Formularies can change at any time

Part D formularies can (and often do) change. The carrier must inform you of these changes, but they still have the right to change the plan.

There is one restriction. The plan cannot change during the Annual Election Period or 60 days after the coverage begins. The only exception to this rule is if the FDA determines that medication is unsafe or ceases to be produced.

When the carrier informs its members of the change, they must include the names of the removed drugs and give alternative suggestions for those drugs. They must also notify you if a drug moved tiers if it has changed the price and any exceptions available.

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