I am reviewing my options for a Medicare Part D plan by using www.medicare.gov. I have entered all the medicines I am currently prescribed. However, what if I am prescribed something next year and the Part D drug plan I select does not cover the new medicine?
To best answer your question, let’s look at the federal rules that apply to Medicare Part D.
The Centers for Medicare and Medicaid Services monitors Part D drug plans to ensure that each Part D drug plan offers an array of medicines that represents practically every therapeutic category of Food and Drug Administration-approved prescription drugs. Specifically, every Part D drug plan must offer at least two “chemically distinct drugs” for close to every class or category of FDA-approved medicines. The list of the medicines covered by your Part D drug plan is termed the plan’s “formulary.”
There are some classes of medicines that every Part D drug plan must offer more than two medicines per class/category. Medicare Part D plans must cover “all, or substantially all” of drugs in the following categories: antidepressants, antipsychotics, anticonvulsants (anti-seizure medicines), antivirals (HIV treatments), anti-cancer and immunosuppressants. If you are diagnosed with a condition and your medicines falls in one of these categories, your Part D drug plan will cover most any drug your doctor prescribes to treat this condition.
However, there are some classes of medicines that federal law prevents Medicare Part D plans from covering. The excluded medicines are: medicines used for weight gain/weight loss, fertility medicines, hair growth medicines, vitamins/minerals products, nonprescription medicines, erectile dysfunction medicines, and medicines used for symptomatic relief of cough and colds.