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Additional Notes on the Medicare Part D Formulary
As noted, a Medicare Part D plan's Formulary is another name for the plan's prescription drug list or guide.
:: Which Prescription Drugs are Excluded from Medicare Part D?
:: Can a Medicare Part D Plan's formulary change?
:: Are In- or Out-patient Medications covered under Part D?
Which Prescription Drugs are Excluded from Medicare Part D?
A certain group of medications are specifically excluded from Medicare Part D plans and they include:- Previous to 2013, certain anti-anxiety and anti-seizure drugs - Barbiturates (Barbiturates include: Pentobarbital (Nembutal), Secobarbital (Seconal), Amobarbital (Amytal) and Phenobarbital (Luminal).) and Benzodiazepines (Benzodiazepines include: Xanax, Klonopin, Valium, Ativan, etc.) Note: See information box below for changes to Barbiturates and Benzodiazepines Medicare Part D coverage starting January 1, 2013.
- Most prescription vitamins and minerals (with the exception of prenatal vitamins and fluoride preparations)
- Prescription drugs used for - anorexia, weight loss or weight gain; fertility; cosmetic purposes or hair growth; relief of symptoms of colds
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Update - As of January 1, 2013, Medicare Part D plans cover barbiturates for certain conditions and benzodiazepines. |
As of January 1, 2013, Medicare Part D prescription drug plans must provide coverage of Barbiturates "when used to treat epilepsy, cancer, or a chronic mental health disorder" and Benzodiazepines. As noted in Section 175 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA):
SEC. 175. INCLUSION OF BARBITURATES AND BENZODIAZEPINES AS COVERED PART D DRUGS.
(a) In general. — Section 1860D-2(e)(2)(A) of the Social Security Act (42 U.S.C. 1395w-102(e)(2)(A)) is amended by inserting after "agents)," the following: "other than subparagraph (I) of such section (relating to barbiturates) if the barbiturate is used in the treatment of epilepsy, cancer, or a chronic mental health disorder, and other than subparagraph (J) of such section (relating to benzodiazepines),". 42 USC 1395w—102(e)(2)(A) (P.L. 110-275, §175(a))
(b) Effective date. The amendments made by subsection (a) shall apply to prescriptions dispensed on or after January 1, 2013.
As a note, previous to this 2013 change, Section 1860D-2(e)(2)(A) of the Social Security Act stated:
(e) Covered Part D Drug Defined.— ...
(2) Exclusions.—
(A) In general.— Such term does not include drugs or classes of drugs, or their medical uses, which may be excluded from coverage or otherwise restricted under section 1927(d)(2), other than subparagraph (E) of such section (relating to smoking cessation agents), or under section 1927(d)(3), as such sections were in effect on the date of the enactment of this part. Such term also does not include a drug when used for the treatment of sexual or erectile dysfunction, unless such drug were used to treat a condition, other than sexual or erectile dysfunction, for which the drug has been approved by the Food and Drug Administration.
(B) Medicare covered drugs.— A drug prescribed for a part D eligible individual that would otherwise be a covered part D drug under this part shall not be so considered if payment for such drug as so prescribed and dispensed or administered with respect to that individual is available (or would be available but for the application of a deductible) under part A or B for that individual.
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:: Read more about Prescription Niacin Coverage
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Can a Medicare Part D Plan's formulary change?
Yes -
A Medicare Part D plan's list of covered prescription drug or Formulary can change with 60 days prior notice to the Medicare Part D plan's participants or members. Each Medicare Part D plans provides information about how you will be notified in the event of a formulary change.
Please note CMS passed recent guidance that protects current plan members from changes to the plan's formulary or drug list! See the link below:
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:: Read more about Formulary Changes and your Rights
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Are In- or Out-patient Medications covered under Part D?
No -
Medicare Part A is covering your inpatient medications (for hospital or skilled nursing stays. Medicare Part B will cover your outpatient medications.
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:: Read more on Medicare A and B coverage
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