When designing Part D, our legislators had to decide on which kinds of medications would be covered. Eliminating some medications from coverage was necessary to try to keep Part D costs down overall.
The medications that Medicare does not require insurance companies to offer in their Part D drug plan formularies are:
Barbiturates are medications that act as a depressant to your central nervous system. They are commonly used for sedation or even anesthesia. Because these drugs have a tendency to cause addiction or dependence, they are not required to be included in the drug formularies for Part D. Examples of barbiturates would be barbital or phenobarbital.
Benzodiazepines are a class of medications commonly prescribed for anxiety, muscle relaxation and also sleeplessness. While considered safer than barbiturates, benzodiazepines can also be addictive, and can cause withdrawal symptoms if they are suddenly discontinued. Some of the more common drugs in this class are Valium (diazepam), Restoril (temazaepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam). Fortunately for Medicare beneficiaries, the generic versions of each of these medications are quite affordable even outside of insurance coverage.
Vitamins & Minerals – some vitamins can be prescribed at dosages high enough to require a prescription. These are not covered by Medicare Part D.
Cosmetic medications – Drugs that are used for reasons unrelated to illnesses or health conditions are also not covered. Common prescriptions for this would be Botox, Latisse and also hair growth medications such as Rogaine or Propecia.
Weight loss or weight gain medication – including drugs prescribed to treat anorexia
Erectile dysfunction or fertility medications – Cialis and Viagra are common examples of meds not covered by Part D. Also, for women on Medicare due to disability, drugs to promote fertility are not recognized as a necessity for Part D.
Cough medicines – cough syrups and expectorants that have higher doses of ingredients like guaifenesin or that include codeine or hydrocodone for help in sleeping are generally not covered. Examples would be Ztuss, Hydcodan, Tussigon and Mycodene.
There are a few insurance companies who choose to offer some of these exceptions on their drug plan formulary. However, since drug carriers can change their formularies each and every year, consumers should be aware that these medications may not always be covered even if they are covered during the first year you enrolled in your Part D plan.
If you take a medication that you are concerned may not be covered, we encourage you to call our agency for help with a Part D drug plan analysis. Our licensed agents can help you find the drug plan that is most cost effective for you, and also help you understand any costs you may incur for medications that are not covered by Part D.