Are There Drugs That Are Excluded In Medicare Part D?
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.
Are There Drugs That Are Excluded in Medicare Part D? Universal Exclusions
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.
Are There Drugs That Are Excluded in Medicare Part D? Formulary Exclusions
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.
How Does One Obtain Necessary Drugs That Are Excluded From Medicare Part D Plans?
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.
One Response to “Are There Drugs That Are Excluded In Medicare Part D?”
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You do not answer the of WHY phenobarbital is not on the formulary for medicare. Since it is not, my prescription plan (Siver Script) will not cover thisw med that I have taken for 50 years for seizures and which I cannot stop taking.
This didn’t use to be an expensive drug as evidenced by the fact that I was required to pay less than the co pay on this drug as compared to any other prescription. Since insurance no longer covers this the price goes up every time it is refilled. The pharmacy tells me there is only one co. making it anymore and they raised the price.
Phenobarbital is the med most critical to my health.
I am a senior who is being exploited.