Part D plans are not all the same. Each Part D plan has a list of drugs that it will cover. This list is called the plan's formulary. A Part D plan's list of covered drugs can be complicated and can change.
Starting January 1, 2013, Medicare Part D began covering barbiturates and benzodiazepines – previously excluded under Medicare. Benzodiazepines are covered as a treatment for all medically necessary conditions. Barbiturates will only be covered to treat epilepsy, certain cancers and chronic mental health conditions.
Certain types of drugs are never covered by Part D. These include:
- over-the-counter drugs (even if they are prescribed by a physician)
- 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 preparations, when prescribed for symptomatic relief only, without underlying medical indication
- 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 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)
Part D plans may not cover other drugs as well.
If you are eligible for Medicaid or VPharm, these drugs are usually covered by Vermont.
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.
If a plan does not cover all the drugs you need, you can ask them to make an exception. If your plan does not cover your drug, or if you need help requesting an exception, call the Health Care Advocate HelpLine at 1-800-917-7787.