Whether you take medication on a daily basis to manage symptoms of a chronic medical condition or you occasionally need prescription drugs to treat acute healthcare concerns, there’s no denying that medications are an important part of the US healthcare system. As a result, many people who receive Medicare benefits opt to take part in Medicare Part D prescription drug plans. Medicare Part D provides a cost-saving benefit to recipients in the form of discounts on many common prescription medications, and since 2006, it has been utilized by millions of Medicare recipients across the country.
Options for Drugs Excluded From Part D Plans
Although Part D prescription drug plans offer benefits for a large number of prescription medications, not all drugs are covered. In order to get help paying for a particular medication, the drug must be included in your plan’s formulary. This formulary is a list of all covered drugs, and it may include specific guidelines for coverage pertaining to dosages covered. If a drug is not listed in your formulary, it is not covered, but you may be able to work with your doctor and plan manager to file an exemption for special coverage.
Additionally, medications that are not available for purchase from a retail pharmacy and drugs that cannot be administered by the patient at home are usually also excluded. Thankfully, if a medication needs to be administered by a healthcare professional or needs to be obtained through a hospital pharmacy for use while admitted to a healthcare facility, it may be covered through Medicare Part A or Medicare Part B, depending on the circumstances.
Supplements and over-the-counter medications are usually excluded from Part D coverage. These products may qualify, however, for benefits or discounts under a Medicare Advantage plan. To learn more, you will need to contact your plan manager directly to discuss your options and needs.
Lifestyle Drugs Excluded
Many drugs that are considered lifestyle medications are usually excluded from Part D coverage despite otherwise meeting all of the requirements for Medicare’s guidelines. These drugs may include things like weight loss drugs and sexual enhancement medications. These drugs may be excluded even if they are purchased in a retail pharmacy and administered at home. Additionally, these drugs may be excluded from Medicare coverage if administered by a healthcare professional or in a hospital setting unless special circumstances require their use to address a medical condition.
An example of this may be where an erectile dysfunction drug is used to address blood flow issues and cardiovascular health. If the medication is prescribed simply to treat erectile dysfunction, it may not be covered, but if it is prescribed for “off-label” use, Medicare Part D may cover it. To be sure that your prescription drugs will qualify, you should work with your doctor to see if any alternatives exist, and then contact your plan manager or administrative office before attempting to fill the prescription to receive a definitive answer.
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