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What Medicare Part D Covers

Medicare Part D plans cover your prescription medications. Each plan has a list of medications it covers called a formulary. The formulary is broken down into tiers, typically by generic, name brand, and so on.

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What does Medicare Part D cover?

Each Medicare Part D plan has a formulary, which is a list of medications it covers. Although a plan's formulary can change at anytime, Medicare requires the plan must offer at least two drugs in each treatment class. 

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  • Antidepressants

  • Antipsychotics

  • Anticonvulsants

  • Immunosuppressants

  • Anti-cancer medications

  • HIV/AIDS drugs

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Part D plans also cover common vaccines to prevent illness.

Drugs Not Covered By Part D

What drugs are not covered?

Prescription drug plans do not cover any medications Original Medicare covers for you. Other than that, there are a few medications that Part D will not typically cover including: 

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  • Any weight loss or weight gain drugs

  • Fertility medication

  • Over-the-counter medication

  • Erectile dysfunction medication

  • Cosmetic drugs

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You may find a Part D carrier that offers these medications, but that is unusual. The above list is not a complete list and can change. If you do feel you need a drug that is not on a formulary you would like to be on, you have the right to ask your plan for an exception.​

Formularies can change at anytime

It is important to know that drugs can come and go from the formulary at any time. However, the insurance company must let you know when any changes are coming. 

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All plans are restricted from making changes to the drugs provided and making price changes between the beginning of the annual election period until 60 days after coverage begins. The only exception is if the FDA determines a drug is unsafe or the manufacturer ceases production of the drug. 

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Any changes must include the name of the drugs removed, if the drug changes tires, the reason for the change, alternate drugs available, any cost sharing, and exceptions available.

  • Weight Loss or Gain Drugs

  • Any Drugs for Hair Growth

  • Fertility Drugs

  • Drugs for Erectile Dysfunction

  • Any Over-The-Counter Drugs

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