To get Medicare prescription drug coverage, you must be enrolled in a Medicare Part D Prescription Drug Plan. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. Medicare Part D Prescription Drug Plan plans vary in cost and in the specific drugs they cover.
Each plan has a list of covered drugs, called a formulary. You should check before joining a Medicare Part D Prescription Drug Plan to ensure that any drugs you need are on that plan’s formulary. If your drug is not on the formulary, you may have to request an exception, pay out of pocket, or file an appeal to ask your plan to cover the drug. While Part D plans are not required to cover all drugs, they are required to cover all antidepressant, anticonvulsant, and antipsychotic medications (with limited exceptions).
Some medications used to treat substance use do not meet certain requirements for coverage under Medicare Part D Prescription Drug Plan. These medications can be covered by Part A during an inpatient stay or by Part B as part of medication-assisted treatment (MAT) at an opioid treatment program (OTP).
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