(855) 760-2227

Medicare Advantage Plans

Starting At $0/ Month

Just give us a little information,
and find out if you have $0 Premium Plans in your area.

Will My Prescription Drugs Be Covered Under Medicare Part D?

If you rely on various medications to maintain your health, it’s good to know that you can secure benefits through a Medicare Prescription Drug Plan, or Part D. But different plans cover different drugs, and it’s sometimes challenging to find a plan that covers the specific medications you use. Here’s some guidance on how to find out if your drugs are covered under Part D, and what to do if they aren’t covered.

First Check the Formulary, or List of Covered Drugs For Any Part D Plan You Are Interested In

Each Medicare drug plan has its own list of covered drugs, called a formulary. In most cases, covered drugs are classified into tiers, with drugs in the lowest tier costing less than those in higher tiers. If you are interested in joining a Part D plan, be sure to review the formulary to ensure your drugs are on the list. Remember, each plan is different, with different formularies. If you don’t see your drugs listed, check another plan.

Formularies often change yearly, meaning your drugs may no longer be available next year, even if they are covered this year. Sometimes, covered drugs change tiers, or move between classifications. Even if you are happy with your Part D coverage, it is essential that you review your plan’s Annual Notice of Change, along with the formulary for the upcoming year to avoid being surprised at the pharmacy. 

Some Drugs are Covered By Original Medicare, Part A and Part B

In some cases, Original Medicare covers drugs that Part D does not. For instance, vaccines, cancer drugs, and certain injectable prescription drugs are covered under Medicare Part B if you receive them in an outpatient setting, like your doctor’s office.

Some Drugs are Not Covered By Medicare Part A, Part B, or Part D

It’s important to know which medicines may be covered under your Medicare health plan, and which are not. Neither Original Medicare nor Medicare Part D provides benefits for over-the-counter drugs. For instance, cough and cold medicine, vitamins, medication for hair growth, and medication designed to treat sexual dysfunction are not covered. 

What to Do If Your Drugs are Not Covered Under Medicare

In the event you realize your drugs are not covered under a current Part D plan or Original Medicare, there are a few things you can do.

Ask your doctor if there are substitutes available. In many cases, formularies do not cover brand-name drugs but do offer coverage for generic, or low-cost alternatives. You can also ask your doctor if there is another drug that may work the same as one that is not available through your Part D plan.

Request a formulary exception. Medicare is open to listening to your doctor if he or she believes that a specific drug is the only medication that will help your condition. A formulary exception may be granted if your doctor and Medicare agree that the drug is medically necessary for your health. You also have the right to file an appeal should Medicare deny your request for a formulary exception.

Switch to a new Part D plan. Each Part D plan is different, and it is possible that your drugs are covered under a different plan’s formulary. If your current plan no longer covers your medication, and you find a new plan that does, you can switch during Annual Enrollment Period (October 15 – December 7) each year.






Leave a Reply

Your email address will not be published. Required fields are marked *

Testimonial Jenn, Thank you for helping me with this, what I thought was a confusing task, you have made it simple and very pleasant. You are an excellent professional. Once again, you are absolutely the best. Thank you for making it so easy and solving a very unsettled status in my life.” S. Randall, Refugio
Testimonial With Jenn’s help, I found a plan that was perfect for my wife and I retirement needs and saved us money from what we had been paying. Thank you for always answering our questions, calls and emails. C. Richards, Houston
Testimonial Lesli’s professional manner and her ability to explain the policy to me made my decision to select a supplemental policy for my retirement an easy one. I would highly recommend her to my friends. Thank you Ronald Hornburg, Cypress

Latest News

Read all the news

Why Choose Consumers Direct Insurance Services of Texas?

Looking for a unique and genuine insurance experience? We’re here to help! We know that dealing with insurance isn’t always…
Read more

Medicare Part A and B Explained

Like most seniors, there’s a good chance you’ve heard of Medicare – you may even know that it’s a federally…
Read more

Is Medicare a Advantage Good Deal?

Medicare Advantage (MA or Part C), is a popular alternative to traditional Medicare. Since 2010, enrollment increased by 71 percent,…
Read more

Medicare Readiness Checklist

9 to 12 months before you turn 65 Confirm that you are eligible to receive Medicare benefits by calling the Social Security…
Read more

Medicare Annual Enrollment Period – 5 Questions and Answers

The annual Enrollment Period (AEP), is the one time of year when you can make changes to an existing Medicare…
Read more