What drugs are excluded from Part D coverage? - Community Health Plan of Washington - Medicare Advantage

What drugs are excluded from Part D coverage?

When a drug is excluded from coverage, this means that Medicare does not pay for the drug. There are three general rules about drugs that Medicare drug plans will not cover under Part D: Part D drug coverage cannot cover a drug that would be covered under Part A or Part B; we cannot cover a drug purchased outside of the United States and its territories; usually we cannot cover off-label use. “Off-label use” is defined as the use of the drug other than those indicated on a drug’s label as approved by the Food and Drug Administration.

Additionally, by law, Medicare Part D cannot cover the following categories of drugs:

  • Over-the-Counter, or non-prescription drugs
  • Drugs used to promote fertility
  • Drugs used for cough and cold symptoms
  • Drugs used for cosmetic purposes or to promote hair growth
  • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
  • Drugs when used for the treatment of sexual or erectile dysfunction
  • Drugs when used for the treatment of anorexia, weight loss, or weight gain
  • Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale

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