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

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