What Part D Covers

Medicare Part D provides coverage for most retail prescription drugs in the United States by requiring each plan to maintain a formulary listing the medications it covers. Plans are mandated to offer at least two drugs in each therapeutic class and include all or most drugs in specific categories, such as antidepressants, antipsychotics, anticonvulsants, immunosuppressants, anti-cancer medications, and HIV/AIDS drugs. These requirements ensure that any enrolled drug plan will offer a wide range of medications for future illnesses. Additionally, Part D plans cover various common vaccines like the shingles vaccine for preventive care.

However, there are certain types of medications that Medicare does not compel drug plan carriers to include in their formularies, including barbiturates, benzodiazepines, fertility or erectile dysfunction drugs, cosmetic medications, weight-related drugs, prescription-strength vitamins, cold symptom treatments, and compound medications. While some carriers may choose to include these exceptions in their plans, they have the discretion to remove them from the formulary each year during plan re-filing with Medicare.

Certain medications are categorized under Medicare Part B rather than Part D. If you have Original Medicare with a traditional Supplement, these drugs will typically be fully covered. However, if you have chosen a Medicare Advantage plan, you will need to pay the co-insurance specified in your plan’s benefits summary. This could entail a 20% cost-share under many Medicare Advantage plans, although any spending on Part B will contribute towards reaching your plan’s out-of-pocket maximum.

The main types of prescriptions that may fall within the scope of Part B include:

– Medications administered at a physician’s office like chemotherapy drugs
– Drugs dispensed through durable medical equipment such as nebulizers or pumps
– Immunosuppressive drugs commonly prescribed post organ transplant
– Certain oral cancer treatments or anti-nausea medications self-administered by patients
– Medications for End-Stage Renal failure like Erythropoietin
– Drugs provided during hospital outpatient care
-Vaccines recommended by healthcare providers e.g., pneumonia or hepatitis vaccines
-Blood clotting factors and diabetes supplies including lancets, test strips, and glucose monitors

Before selecting your Medicare Part D drug coverage plan it is vital to comprehend how this program operates along with any regulations and restrictions associated with available plans.