What prescriptions does Part D cover?

If you are thinking about signing up for Medicare Part D, you likely understand that Original Medicare only covers medications you receive during doctor visits and hospital stays. Otherwise, Original Medicare doesn’t cover prescription drugs. This is where Part D can help.

You can get your Part D coverage either through the Medicare Part C prescription drug plan or a standalone Medicare Part D prescription drug plan. Health insurance companies contracted by Medicare provide these plans, so the carriers ultimately decided which prescription drugs to cover under its prescription drug plan.

What Does Medicare Part D Cover?

All Medicare prescription drug plans must cover certain categories of medications, but the specific medication in each category may vary by the provider. However, there are six categories of prescription drugs that Part D plans must cover all prescriptions in. The six categories include:

  • Antipsychotic medications
  • Antidepressants
  • HIV/AIDS treatments
  • Immunosuppressant medications
  • Anticonvulsive treatments for seizures
  • Anticancer drugs

Medicare Part D is also needed to cover commercially available vaccines such as the shingles shot. Medicare Part D must also cover a range of brand name and generic prescription drugs usually required by populations on Medicare and available only by prescriptions.

What Doesn’t Medicare Part D Cover?

There are certain types of medications that Medicare Part D plans don’t usually cover:

  • Fertility medications
  • Medications to control weight
  • Prescription drugs for erectile dysfunction
  • Prescription drugs for hair growth or cosmetic purposes
  • Over-the-counter medications for cold symptoms

Changes in a Part D Formulary

Medicare requires each plan to have a formulary listing the prescriptions that are covered. The Medicare Part D plan must also inform you when it makes changes to its formulary. You should receive a notice from your Medicare Part D plan whenever the formulary is changed.

Medicare Part D plans are regulated and limited from making changes to their listed prescription drugs or change the tiered pricing. However, when the FDA determines that a particular drug is no longer safe or the manufacturer removes the medication from the market, there is an exception.

Learn More About Medicare Part D Coverage

If you are unsure which Part D plan is right for you, reach out to Generations Insurance today! We can help you establish your prescription drug coverage needs and find a plan that offers the coverage.