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Are all of my prescription medications covered by Medicare Part D?
—Lara (Scarsdale, New York)
Click on the blue, underlined hyperlinks for related information available through Medicare Interactive!
Not all prescription medications are covered by Part D. In fact, certain medications are excluded from coverage by Federal law.
Drugs prescribed for anorexia, weight loss or weight gain (except to treat physical wasting caused by AIDS, cancer or other diseases), fertility, cosmetic purposes or hair growth, relief of the symptoms of colds, erectile dysfunction, prescription vitamins and certain anti-anxiety drugs are all excluded from coverage.
Additionally, if your doctor prescribes a non-cancer medication on the formulary for a reason other than the use approved by the U.S. Food and Drug Administration, your drug will probably not be covered unless the use is listed in one of three Medicare-approved drug compendia (medical encyclopedias of drug uses). For anti-cancer drugs, your drug plan should accept indications of drug use from additional compendia and other peer-review medical literature.
You may also receive a denial from your part D plan stating that your drug does not meet “DESI standards.” The FDA’s Drug Efficacy Study Implementation (DESI) evaluates the effectiveness of those drugs that had been previously approved on safety grounds alone. Drugs that are found to be “less than effective” by DESI evaluation are excluded from coverage by Part D.
www.medicareinteractive.org/"> To find out more about Part D drug coverage, go to Medicare Interactive. You can compare Medicare prescription drug plans on Medicare.gov.
most companies do not cover benzodiazepans as well. also the generic for protonics is new and payment is in the $20-#30 range. i am close to donut hole, and now am going to pharmacies that offer generics -3 mos./$10 and save my insurance for the expensive drugs.