Prescription drug coverage is an important benefit for Medicare recipients. Medicare Prescription Drug Plans (Part D) may be purchased from private insurance companies that are contracted with Medicare to provide and manage prescription benefits to beneficiaries. Seniors who choose Original Medicare can purchase a standalone Medicare Prescription Drug Plan; those who are enrolled in a Medicare Advantage Plan typically have their Part D needs met there. Every Part D Plan and Medicare Advantage Plan must provide certain types of prescription drugs in its formulary, but the list of specific drugs that are covered is ultimately up to the insurance company.
While certain drugs must be covered under Medicare, there is also a list of drugs that are never covered by Medicare for various reasons.
Drugs not covered by Medicare
A Part D-covered drug must be FDA-approved, prescription medication with a compendial indication. Based on this definition, there are many drugs that Medicare plans will not cover under Medicare Part D. The list includes:
Drug efficacy study implementation (DESI) drugs
Drugs that assist with fertility
Drugs for weight management, including anorexia, weight loss or weight gain
Prescription vitamins and mineral products (prenatal vitamins and fluoride preparations are an exception)
Drugs prescribed for cosmetic purposes or hair growth
Drugs that provide relief of cough and cold symptoms
Drugs for sexual dysfunction