{"id":56347,"date":"2023-01-09T10:56:38","date_gmt":"2023-01-09T15:56:38","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=56347"},"modified":"2024-10-25T10:56:59","modified_gmt":"2024-10-25T14:56:59","slug":"what-drugs-are-covered-by-medicare-part-d","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/what-drugs-are-covered-by-medicare-part-d\/","title":{"rendered":"What drugs are covered by Medicare Part D?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Medicare Part D is the part of Medicare that covers most prescription drugs. Medicare Part D is optional, but if you don&rsquo;t have creditable drug coverage, you may owe a <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-d-penalty\/\"><span style=\"font-weight: 400;\">Part D penalty<\/span><\/a><span style=\"font-weight: 400;\"> if you decide to enroll later.<\/span><\/p>\n<h2 id=\"does-medicare-part-d-cover-all-prescriptions\"><span style=\"font-weight: 400;\">Does Medicare Part D cover all prescriptions?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Each Medicare Part D plan has its own <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-formulary\/\"><span style=\"font-weight: 400;\">formulary<\/span><\/a><span style=\"font-weight: 400;\">. A formulary is the plan&rsquo;s covered drug list and covered <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-vaccine-coverage\/\"><span style=\"font-weight: 400;\">vaccines<\/span><\/a><span style=\"font-weight: 400;\">. The formulary allows you to see if the plan covers the drugs you use most, and with the fewest restrictions, before enrollment.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8220;Part D plans cover both brand-name and generic medications,&rdquo; said Valenzuela. &ldquo;In addition, there are specific protected classes of drugs, such as those used to treat seizures, cancer, and HIV\/AIDS. Medicare Part D plans are required to cover most drugs in these protected classes.&rdquo;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While each plan covers different drugs, they must cover at least two drugs in the 146 different drug categories. Examples of drug categories that are popular for Medicare users include:&nbsp;<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Angiogenesis inhibitors,<\/b><span style=\"font-weight: 400;\"> or <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-cancer-treatment\/\"><span style=\"font-weight: 400;\">cancer-fighting agents<\/span><\/a><span style=\"font-weight: 400;\">, including prescriptions like Revlimid (lenalidomide) or Votrient<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/anticoagulants\"><b>Anticoagulants<\/b><\/a><span style=\"font-weight: 400;\"> that thin blood and reduce blood clots, like <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/eliquis-assistance-for-medicare-patients\/\"><span style=\"font-weight: 400;\">Eliquis (apixaban)<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/factor-xa-inhibitors\"><b>Factor Xa inhibitors<\/b><\/a><span style=\"font-weight: 400;\">, another blood thinner, like <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/xarelto-assistance-for-medicare-patients\/\"><span style=\"font-weight: 400;\">Xarelto (rivaroxaban)<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/glp-1-agonists\"><b>GLP-1 receptor agonists<\/b><\/a><span style=\"font-weight: 400;\">, which increase the production of insulin, like Trulicity<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Note: GLP-1 agonists are only covered by Medicare if they are prescribed to treat diabetes&mdash;not weight loss.&nbsp;&nbsp;<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>TNF blocking agents<\/b><span style=\"font-weight: 400;\">, which treat arthritis, like Humira<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Immunosuppressants<\/b><span style=\"font-weight: 400;\">, including <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/corticosteroids\"><span style=\"font-weight: 400;\">corticosteroids<\/span><\/a><span style=\"font-weight: 400;\"> like prednisone<\/span><\/li>\n<\/ul>\n<h3 id=\"what-drugs-are-not-covered-by-medicare-part-d\"><span style=\"font-weight: 400;\">What drugs are <\/span><i><span style=\"font-weight: 400;\">not<\/span><\/i><span style=\"font-weight: 400;\"> covered by Medicare Part D?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Although Medicare Part D covers many prescription drugs, it doesn&rsquo;t cover everything. Part D does not cover anorexia, hair loss, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-erectile-dysfunction\/\"><span style=\"font-weight: 400;\">erectile dysfunction<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/obesity-and-health-insurance\/\"><span style=\"font-weight: 400;\">obesity<\/span><\/a><span style=\"font-weight: 400;\">, over-the-counter medications, or vitamins.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Although uncommon, if these drugs are prescribed to treat a different indication other than those <\/span><a href=\"https:\/\/www.cms.gov\/medicare\/prescription-drug-coverage\/prescriptiondrugcovcontra\/downloads\/partddrugspartdexcludeddrugs.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">excluded by Part D coverage<\/span><\/a><span style=\"font-weight: 400;\">, you may receive coverage. For example, Part D will not cover <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-ozempic\/\"><span style=\"font-weight: 400;\">Ozempic<\/span><\/a><span style=\"font-weight: 400;\"> if it&rsquo;s prescribed for weight loss; however, it may be covered if Ozempic is prescribed for diabetes treatment.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Additionally, there are occasions where Medicare Part A or B may cover prescription drugs that are not covered by Part D:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If someone is hospitalized and given drugs over the course of their treatment, Part A will typically cover all the drugs they were given during that time.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-b-drugs\/\"><span style=\"font-weight: 400;\">Part B will generally cover drugs<\/span><\/a><span style=\"font-weight: 400;\"> when they&rsquo;re ones you don&rsquo;t administer yourself and need to go into a healthcare provider&rsquo;s office to have administered like an injected drug.<\/span><\/li>\n<\/ul>\n<h2 id=\"part-d-formulary-restrictions\"><span style=\"font-weight: 400;\">Part D formulary restrictions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Drug formularies are broken into different drug tiers. Higher-tier drugs (usually brand names) typically cost more than lower-tier drugs (usually generics) and may have more restrictions.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Occasionally, an insurance plan will require <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/step-therapy\/\"><span style=\"font-weight: 400;\">step therapy<\/span><\/a><span style=\"font-weight: 400;\">, meaning you have to try the lower-cost drugs before being approved for a higher-tier drug.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Other plans may require <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\"> for specific drugs.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some tiers of drugs also may not apply to your deductible, depending on your Part D coverage.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There also may be <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/quantity-limits\/\"><span style=\"font-weight: 400;\">quantity limits<\/span><\/a><span style=\"font-weight: 400;\"> on certain prescription drugs.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">People with Medicare typically should seek out a Part D plan that covers as many of their drugs as possible, with the fewest restrictions, at the lowest cost.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Occasionally, a plan&rsquo;s formulary will change while you are covered. Sometimes, The Food and Drug Administration (FDA) may recall a prescription drug due to safety or efficacy, so it&rsquo;s taken off the plan&rsquo;s formulary. If any of the drugs you&rsquo;re on are being discontinued from the plan, your coverage is required to notify you in writing 30 days before the change. Then, you&rsquo;re able to get another month of your prescription refills before it changes.&nbsp;<\/span><\/p>\n<h2 id=\"what-if-a-drug-is-not-covered-by-medicare-part-d\"><span style=\"font-weight: 400;\">What if a drug is not covered by Medicare Part D?&nbsp;<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If a prescription drug you need is not covered by your Medicare Part D formulary, you have a couple of options. Many plans allow you to fill out an exception request stating why you need the specific drug covered by your insurance company. There is also a formal appeals process when a drug is denied, which can be escalated many times.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You can also pay out of pocket, covering 100% of the costs rather than just the copayment. In this case, a <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">free SingleCare discount card<\/span><\/a><span style=\"font-weight: 400;\"> could come in handy.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another option is to talk to your healthcare provider about finding an alternative drug that <\/span><i><span style=\"font-weight: 400;\">is<\/span><\/i><span style=\"font-weight: 400;\"> covered by your plan.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">During the Open Enrollment Period, you should look for a Part D plan with a formulary that <\/span><i><span style=\"font-weight: 400;\">does<\/span><\/i><span style=\"font-weight: 400;\"> cover the drug you require, with the fewest restrictions, at the lowest cost.<\/span><\/p>\n<h2 id=\"how-to-save-on-prescription-drugs\"><span style=\"font-weight: 400;\">How to save on prescription drugs<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">There are a few other options to save on prescription drug costs.<\/span><\/p>\n<h3 id=\"extra-help\"><span style=\"font-weight: 400;\">Extra Help<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">For those with Medicare coverage and limited income and assets, you can potentially qualify for the <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-extra-help\/\"><span style=\"font-weight: 400;\">Extra Help<\/span><\/a><span style=\"font-weight: 400;\"> program. It helps cover out-of-pocket expenses like co-payments, premiums, coinsurance, and yearly deductibles. You can see if you qualify on the <\/span><a href=\"https:\/\/secure.ssa.gov\/i1020\/Ee006aView.action\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Social Security Administration&rsquo;s website<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"singlecare\"><span style=\"font-weight: 400;\">SingleCare<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">People who use SingleCare instead of Medicare could save up to 80% on their prescriptions. Simply search for your prescription drug on <\/span><a href=\"https:\/\/www.singlecare.com\/\"><span style=\"font-weight: 400;\">singlecare.com<\/span><\/a><span style=\"font-weight: 400;\"> or take your prescription discount card to the pharmacy and see what savings you can get on your medicine.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Medicare Part D is the part of Medicare that covers most prescription drugs. Medicare Part D is optional, but if you don&rsquo;t have creditable drug coverage, you may owe a Part D penalty if you decide to enroll later. Does Medicare Part D cover all prescriptions? Each Medicare Part D plan has its own formulary. [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":56349,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[15,4350],"coauthors":[15090],"class_list":["post-56347","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-medicare","tag-prescription-savings","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What drugs are covered by Medicare Part D? | SingleCare<\/title>\n<meta name=\"description\" content=\"Each Medicare Part D plan has a formulary that dictates which drugs are covered and the price. Learn what to do if your drug is not covered and how to save.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.singlecare.com\/blog\/what-drugs-are-covered-by-medicare-part-d\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What drugs are covered by Medicare Part D?\" \/>\n<meta property=\"og:description\" content=\"Each Medicare Part D plan has a formulary that dictates which drugs are covered and the price. Learn what to do if your drug is not covered and how to save.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.singlecare.com\/blog\/what-drugs-are-covered-by-medicare-part-d\/\" \/>\n<meta property=\"og:site_name\" content=\"The Checkup\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/singlecare\" \/>\n<meta property=\"article:published_time\" content=\"2023-01-09T15:56:38+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-10-25T14:56:59+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.singlecare.com\/blog\/wp-content\/uploads\/2023\/01\/what-drugs-are-covered-by-medicare-part-d.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1920\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Rebecca Rovenstine\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@SingleCare\" \/>\n<meta name=\"twitter:site\" content=\"@SingleCare\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Rebecca Rovenstine\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/what-drugs-are-covered-by-medicare-part-d\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/what-drugs-are-covered-by-medicare-part-d\\\/\"},\"author\":{\"name\":\"Christie Falzone\",\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/#\\\/schema\\\/person\\\/5ff7c7bb5ce0c66a6962ecf7c8d7941e\"},\"headline\":\"What drugs are covered by Medicare Part D?\",\"datePublished\":\"2023-01-09T15:56:38+00:00\",\"dateModified\":\"2024-10-25T14:56:59+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/what-drugs-are-covered-by-medicare-part-d\\\/\"},\"wordCount\":898,\"publisher\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/what-drugs-are-covered-by-medicare-part-d\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/wp-content\\\/uploads\\\/2023\\\/01\\\/what-drugs-are-covered-by-medicare-part-d.png\",\"keywords\":[\"Medicare\",\"Prescription savings\"],\"articleSection\":[\"Company\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/what-drugs-are-covered-by-medicare-part-d\\\/\",\"url\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/what-drugs-are-covered-by-medicare-part-d\\\/\",\"name\":\"What drugs are covered by Medicare Part D? | SingleCare\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/what-drugs-are-covered-by-medicare-part-d\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/what-drugs-are-covered-by-medicare-part-d\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/wp-content\\\/uploads\\\/2023\\\/01\\\/what-drugs-are-covered-by-medicare-part-d.png\",\"datePublished\":\"2023-01-09T15:56:38+00:00\",\"dateModified\":\"2024-10-25T14:56:59+00:00\",\"description\":\"Each Medicare Part D plan has a formulary that dictates which drugs are covered and the price. 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