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What Medications are not Covered by Medicare?

a variety of prescription drugs on table

Medicare does not cover every drug on the market and certain classes aren't covered by Medicare Part D plans. It's recommended you are aware of the items not covered and always check your plan's formulary if you are being prescribed a new medication. That way there will be no surprises at the pharmacy.

Drugs not covered by Medicare:

  • Drugs for anorexia, weight loss, or weight gain

  • Drugs that promote fertility

  • Drugs for cosmetic purposes or hair growth

  • Drugs for the relief of cough and cold symptoms- these are usually available over the counter

  • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations

  • Nonprescription drugs

  • Drugs for sexual dysfunction

  • Non-FDA-Approved products

  • Drug efficacy study implementation (DESI) drugs (drugs the FDA has determined to be safe but not effective)

  • Bulk chemicals in the following STCs: U6I, U6Q, U6U, U6W, and U6X Bulk chemicals do not meet the definition of a Part D-covered drug (FDA-approved, prescription medication with a compendial indication)

  • Devices (i.e., diaphragms)

  • Ingredient/adjuvant (i.e., sterile water for injection)

  • Line flush (i.e., normal saline IV flush, Heparin Sodium Lock Flush)

  • Medical supplies

  • Drugs covered under Medicare Part A or Part B

Medications not covered by your insurance can be purchased out-of-pocket, may qualify for manufacturer's discounts or available at a reduced price from the various drug discount card programs that are available online.

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