Medicare Part D will only cover FDA-approved prescription drugs, prescribed biologicals, and medical supplies associated with injection of insulin. However, a Part D Plan or a Medicare Advantage Plan may not cover all drugs. Certain drugs are excluded from all plans, including drugs for:
- Anorexia, weight loss, or weight gain
- Cosmetic purposes or hair growth
- Relief of coughs and colds
- Vitamins and minerals
Each Part D Plan has a list of drugs it covers (called a formulary). Plan formularies are required to cover almost all drugs of the following types:
- Cancer medications
- HIV medications
- AIDS medications
Plans may also create pricing tiers. The tier with the lowest prices may be the generic drugs, and then there may be higher priced tiers for different brand name drugs.
Your plan might also require that you get prior approval from the plan for certain drugs, or require that you try an alternate drug first before you try a drug that your doctor would otherwise prescribe.
Part D Plans may change the drugs on their formularies. But if they do, they must post any changes on their websites.
Also, if you have been taking a drug that your plan intends to drop, they must give you 60 days written notice of the change so that you can make changes in your drugs or in your Plan. If you don’t get this advance notice, your plan must give you a 60 day supply of the drug at the time of refill.
However, you cannot leave the plan because of a change in the formulary until the next annual election period (October 15 - December 31 each year).