Many Medicare beneficiaries wonder, are there drugs that are excluded in Medicare Part D? Unfortunately, some drugs are excluded in Medicare Part D. Some of the drug exclusions apply to all standard plans, while others depend on the formulary of the particular Medicare Part D plan chosen by the beneficiary.
Some medications are excluded from all standard Medicare Part D plans. These drugs include barbiturates, such as phenobarbital and secobarbital, and benzodiazepines, such as diazepam and clonazepam. Other non-covered medications include over-the-counter drugs, prescription vitamins except prenatal and fluoride supplements, fertility drugs, drugs used for cosmetic purposes, and drugs used to promote weight loss or gain.
Each Medicare Part D coverage plan publishes a formulary of covered drugs. The United States Government mandates that Medicare Part D plans cover a certain number of drugs in each class, but leaves the decision of which specific medications to cover to the insurance company. When choosing a Medicare Part D plan, the recipient should carefully consider each plan’s formulary to ensure that current prescriptions will be covered without interruption.
Some Medicare Part D plans, which offer greater than standard coverage and charge higher premiums, will cover the excluded drugs. Other Medicare recipients will be able to obtain excluded medications through state Medicaid or other drug benefit plans. Formulary exclusions are subject to an appeals process in which the patient’s physician submits justification as to why an excluded drug is medically necessary.