When you are deciding on Part D plan, it is important to compare the plans carefully. Each Part D plan has a list of drugs that it will cover called a “formulary.” If your drug is not on the formulary, you may have to ask for an exception or appeal. Or you may switch plans if you have a special enrollment period. Contact the Health Care Advocate HelpLine if you need help. Call us at 1-800-917-7787 or fill out our Help Request Form.
Federal law prohibits your Medicare Part D plans from cover certain types of drugs, including:
- non–prescription drugs (also called over-the counter-drugs)
- drugs for weight loss or gain, even if used for non-cosmetic purposes, such as to treat morbid obesity (Note: Drugs to treat AIDS wasting and cachexia are NOT excluded.)
- cough and cold symptoms (Note: An FDA approved medicine for relief of cold symptoms may be covered by Part D if prescribed to treat something other than a cold, such as asthma.)
- fertility drugs
- erectile dysfunction drugs, except as medically necessary and approved by the FDA to treat conditions other than sexual or erectile dysfunction
- cosmetic and hair growth drugs (Note: Drugs to treat acne, psoriasis, rosacea and vitiligo are not considered cosmetic.)
- drugs purchased in another country
- vitamins and minerals, except for: niacin products, Vitamin D analogs (when used for a medically accepted indication), prenatal vitamins, and fluoride preparations
- drugs that may be covered under Part A or Part B of Medicare, even if coverage is not actually available (e.g., because the individual has a Part A or B deductible, or does not yet have Part B)
If you are eligible for Medicaid, these drugs may be covered by Vermont Medicaid if you can show that they are medically necessary.
If you have questions about different plans, call the Senior HelpLine at 1-800-642-5119.
You can also get information about each plan's list of covered drugs on Medicare’s website.
