Medicare itself funds an enormous part of the cost of Part D. To keep costs down, they have had to eliminate certain types of medications from coverage. Drugs not covered by Medicare Part D fall into certain classes. Before you worry, let’s also make clear that all Medicare drug plans must cover certain classes of medications, such as anti-cancer or anti-seizure medications. Many
Types of Drugs Not Covered by Medicare Part D
Medicare does not require insurance companies to offer these types of medications:
Barbiturates are medications that act as a depressant to your central nervous system. Doctors prescribe these for sedation and anxiety. These drugs have a tendency to cause addiction or dependence. Barbital or phenobarbital are examples
Benzodiazepines are a class of medications commonly prescribed for anxiety, muscle relaxation and sleeplessness. While considered safer than barbiturates, benzodiazepines can also be addictive They can even can cause withdrawal symptoms if a person suddenly stops using them. Some of the common drugs in this class are Valium (diazepam), Restoril (temazaepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam). Fortunately for Medicare beneficiaries, some of these medications are not too expensive in generic form.
Vitamins & Minerals – Medicare Part D does not cover prescription strength vitamins and minerals.
Cosmetic medications – 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 – Medicare does not require carriers to cover Cialis and Viagra. Medicare also does not recognize fertility drugs as medically necessary.
Cough medicines – Some cough syrups and expectorants are prescription strength. They have higher doses of ingredients like guaifenesin. Others might include codeine or hydrocodone for help in sleeping. These are generally not covered. Examples would be Ztuss, Hydcodan, Tussigon and Mycodene.
About Compound Medications
If you take a special dose that has to be compounded at a compounding pharmacy, this drug usually can’t be found on a formulary. That’s because compound drugs are unique medications compounded specifically for you. You can file an exception with the drug company to try to get it covered, but there are no guarantees. Be prepared that you will likely pay out of pocket for any compound medications.
While Medicare doesn’t require insurance companies to offer these, some do. Occasionally we find some of these medications in a drug plan formulary. However, drug carriers can change their formularies each and every year. Be aware that these insurance carriers may cover a medication one year then drop it from the formulary in a future year. This is why it’s so important to review your Annual Notice of Change letter each fall.
Get Help with Medicare Part D
Do you take one of the medications in these classes? We encourage you to call our agency for help with a Part D drug plan analysis. Our licensed agents provide free help with Medicare Part D for any Medicare beneficiary that has their Medigap plan through us. We can also help you understand any costs you may incur for drugs not covered by Medicare Part D.