Cracking the Code: What's Not Covered by Medicare Part D?

Prescription drug coverage is crucial for individuals on Medicare. Through private insurance companies contracted with Medicare, you can get Medicare Prescription Drug Plans, also known as Part D. These companies oversee providing prescription benefits. If you're on Original Medicare, you can get a separate Medicare Prescription Drug Plan. But if you're on a Medicare Advantage Plan, your Part D needs are typically covered within that plan. Each Part D and Medicare Advantage Plan must cover certain prescription drugs, but the exact list is up to the insurance company.

Even so, Medicare doesn't cover everything. There are some types of medications that Medicare just doesn't cover. If your medication is on this list, don't worry. There are several steps you can take.

The No-Go List for Medicare Part D

To be covered by Part D, a medication must be FDA-approved and have a specified use. But the following medications are not covered by Medicare Part D:

• Over-the-counter medications like Tylenol
• Non-FDA approved medications
• DESI (Drug Efficacy Study Implementation) drugs, which the FDA deems safe but not effective
• Fertility assistance drugs like Clomid and Ovidrel
• Weight management drugs, including those for anorexia, weight loss, or weight gain, like Xenical and phentermine
• Prescription vitamins and mineral products, apart from prenatal vitamins and fluoride preparations, like Cyanocobalamin
• Cosmetic drugs or hair growth drugs, such as Propecia, Renova, and Vaniqa
• Cough and cold symptom relievers like Tessalon
• Sexual dysfunction drugs like Viagra, Cialis, and Levitra
• Devices such as diaphragms
• Bulk chemicals falling under STCs U6I, U6Q, U6U, U6W, and U6X, and any substances that do not fit the definition of a Part D-covered drug
• Ingredients/adjuvants like sterile water for injection
• Line flushes, such as regular saline IV flush, Heparin Sodium Lock Flush
• Medical supplies including ethyl alcohol and Biafine
• Drugs covered under Medicare Part A or Part B, like Xeloda, Temodar, and Advate

What to Do if Your Drug Isn't Covered

If you're taking a medication not covered by your Part D plan, here are a few things you can try:

• Request a temporary supply of your medication
• Talk to your doctor about switching to a drug your plan does cover
• Use an RxLess discount coupon to get up to 88% off your medication without using your Medicare coverage
• Ask the drug manufacturer about programs that help with the cost of uninsured prescriptions
• Ask your plan for an exception for your drug
• Think about upgrading to a more comprehensive Part D plan. If you need expensive drugs, it might be worth paying higher monthly premiums for a plan that covers excluded drugs.

There are many prescription drug plans available for seniors on Medicare. It's crucial to find a plan that covers the medications you need. Don't hesitate to seek help from your Medicare agent to guide you through the process.