What Is the Medicare Part D Coverage?

Medicare Part D Prescription Drug Plans (Part D) cover outpatient prescription drugs. Each Part D plan has its own formulary, which is a list of drugs that a plan covers.

The law requires all Part D plan formularies to include at least two drugs in most categories—or classes—of drugs, and substantially all drugs in the following six classes:

  • Immunosuppressants, which are used to prevent an individual’s body from rejecting an organ after a transplant
  • Antidepressants, which are used to treat depression
  • Antipsychotics, which are used for schizophrenia and bipolar disorder
  • Anticonvulsants, which are used to treat epileptic seizures
  • Antiretrovirals, which are used to treat HIV and AIDS
  • Antineoplastics, which are used to prevent the development of tumors

Some drugs are excluded from Medicare coverage by law and cannot be covered by any Part D plan. These include:

  • Drugs used to treat anorexia, weight loss, or weight gain; however, Part D may cover drugs used to treat physical wasting caused by AIDS, cancer, or other diseases.
  • Fertility drugs
  • Drugs used for cosmetic purposes or hair growth
  • Drugs that are only used to treat cough or cold symptoms
  • Drugs used to treat erectile dysfunction
  • Drugs that have not been approved by the Food and Drug Administration (FDA)
  • Prescription vitamins and minerals, except for prenatal vitamins and fluoride preparations
  • Most over-the-counter drugs, like Tylenol® and Advil®

Read Next: Are Vaccines Covered by Part D Prescription Drug Plans?
Find Out: What Are the Part D Prescription Drug Plan Costs?
Return to: Medicare Part D

This content was created and copyrighted by the Medicare Rights Center ©2020. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.

YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.