Medicare Part D Coverage and Exclusions
A formulary is the list of prescription drugs that a health plan covers. When you enroll—online or by phone—we review whether the plans you're considering cover the medications you take. To begin, add your prescription drugs to your Profile. For additional information, read Create or Update Your Profile on the Website.
If you need coverage details after enrolling, contact your plan's insurance carrier. The sections below outline what Medicare Part D covers, which drugs are excluded by law, and when exceptions may apply.
What Medicare Part D Generally Covers
Medicare Part D covers prescription drugs that meet all of the following criteria:
They are only available by prescription.
They are approved by the U.S. Food and Drug Administration (FDA).
They are sold and used within the United States.
They are used for a medically accepted purpose.
They are not already covered under Medicare Part A or Part B.
Drugs Excluded by Law from Medicare Part D
Federal law prohibits Medicare Part D from covering certain types of drugs, including:
Drugs covered by Medicare Part A or Part B
Drugs only available from the manufacturer and require testing
Over-the-counter (OTC) drugs
Most prescription vitamins and minerals, except:
Niacin (when prescribed to treat a condition)
Prenatal vitamins
Fluoride
Drugs used for the following:
Anorexia, weight loss, or weight gain (unless the drug treats certain symptoms from AIDS, cancer, or other diseases)
Hair growth or cosmetic purposes (Drugs used for the treatment of psoriasis, acne, rosacea, or vitiligo are not considered cosmetic drugs and may be covered.)
Fertility
Erectile dysfunction
Cold symptom relief (e.g., stuffy nose)
Important Exception
Even if a drug falls into one of the categories above, Medicare Part D may cover it if it is prescribed to treat a different, medically accepted condition and the medication is FDA‑approved for that use.
For example:
A medication sometimes used for cold symptoms may be covered if your doctor prescribes it to treat another condition, such as shortness of breath resulting from severe asthma.