Medicare Part D -

Prescription Drug Coverage

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Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with your Medicare Advantage Plan.

Unless you have creditable drug coverage and will enroll during your Special Enrollment Period, you should enroll in Part D when you first get Medicare. If you delay enrollment, you may face gaps in coverage and enrollment penalties that will last the lifetime of your coverage. 

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Medicare defines creditable drug coverage as an insurance plan that is expected to pay on average as much as the standard Medicare prescription drug coverage.

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Part D Coverage

Each Part D plan has a list of covered drugs, called its formulary. If the drug you need is not on the formulary, you may request an exception, pay out of pocket, or file an appeal.

A drug category is a group of drugs that treat the same symptoms or have similar effects on the body.

 

All Part D plans must include at least two drugs from most categories and must cover all drugs available in the following categories:

• HIV/AIDS treatments

• Antidepressants

• Antipsychotic medications

• Anticonvulsive treatments for seizure disorders

• Immunosuppressant drugs

• Anticancer drugs (unless covered by Part B)

 

Part D plans must also cover most vaccines, except for vaccines covered by Part B.

 

Drugs used to treat weight loss or gain, over-the-counter drugs, and some others are explicitly excluded from Medicare coverage by law.

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Note: For certain drugs or under specific circumstances, your drugs may be covered by Part A or Part B.