What Drugs Are Covered By Medicare Part D?

Original Medicare, which includes both hospital and medical care, can’t cover everything you need. This especially includes prescriptions drugs not administered during your inpatient stay or directly by doctors as part of treatment.

This is where Medicare Part D comes in.

What is Medicare Part D?

Medicare Part D is the federally-provided health insurance policy for prescription drugs. You choose a specific combination of prescription drugs, and pay the premium and other insurance-related expenses for this.

What Drugs are Covered by Medicare Part D?

A drug plan is also called a formulary. Each formulary has a different combination of drugs on its covered list. This formulary depends on the private healthcare provider who manages the Part D plan, and on your state. What we can give you are general ideas of what will and will not be covered by Medicare Part D.

Drugs covered:

  • Those that are prescribed by the doctor giving you treatment or advising preventive care;
  • Vaccines that are advised by the doctor to prevent illness;
  • A range of medicines used to treat or prevent various illnesses (the content is based on the formulary);
  • At least two kinds of medicine in each therapeutic drug class.

Even antidepressants and antipsychotics, immunosuppressant drugs (important for transplant patients), chemotherapy agents, seizure medications, and drugs related to HIV/Aids should be covered in every Part D plan.

As with the law, it is easier to enumerate what drugs are usually not covered. This will help you manage your preferences when you choose your formulary.

Drugs not covered:

  • Those related to either weight gain or loss;
  • Those related to cosmetics or hair;
  • Those related to fertility or similar issues;
  • Drugs given over the counter (those that do not require a doctor’s prescription);
  • Drugs already covered by Medicare Part A and Part B.

Let’s break that down a little, to help you figure out what should be in your Part D plan. What is covered by Parts A and B?

Part A drug coverage includes everything you receive as an inpatient at the hospital. They are automatically covered.

Part B drug coverage tries to extend its range to everything related to medical insurance. This means your drugs covered include:

  • Drugs related to chemotherapy, even including any anti-nausea medication you are prescribed;
  • Immunosuppresant medications prescribed for a Medicare-covered organ transplant;
  • Any medication you use related to End-Stage Renal Disease, which is one of the exemptions that automatically qualifies you for Medicare;
  • Allergy shots given by the physician or healthcare professional;
  • Prescribed blood-clotting drugs for those with hemophilia;
  • Immune Globulin (IVIG) for those diagnosed with autoimmune or immune-deficiency diseases;
  • Drugs related to osteoporosis for women who already experienced a fracture;
  • Vaccinations or medications that treat conditions that come with age and loss of mobility;
  • Hepatitis B shots for those diagnosed “at risk”;
  • Flu shots;
  • Pneumonia shots.

If you have Part B, Part D should not need to cover anything but supplemental drugs depending on your need. However, you will need a Part B or a Part C (Medicare Advantage Plan) equivalent to make your Part D plan worthwhile. Otherwise, you may find that no Part D plan is comprehensive enough for the kind of coverage you want or need.

Medicare Part D Coverage: An Important Consideration

Review your Medicare Parts A and B carefully, and know when it would be wisest to enroll in Part D as well. Taking time to do this will make your decision much quicker when it comes to planning for your future.

James Donaldson

I like to blog about insurance, health and the great outdoors. Memphis born and raised.