Medicare Part D Excluded Drugs

Generally, Medicare Part D only covers drugs that meet all of the following conditions:

• Only available by prescription

• Approved by the Food and Drug Administration (FDA)

• Sold and used in the United States

• Used for a medically accepted purpose

• Not already covered under Medicare Part A or Part B

By law, certain drugs are excluded from Medicare Part D coverage, including the following:

• Drugs covered by Medicare Part A or Part B

• Drugs only available from the manufacturer that require testing

• Over-the-counter (OTC) drugs

• Prescription vitamins and minerals except for:

  • Niacin (when prescribed only 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

  • Fertility

  • Erectile dysfunction

  • Cold symptom relief (i.e., cough and stuffy nose)

Note: Even though prescription drugs used for any of the conditions listed above aren't covered by Medicare Part D, these drugs may be covered if they're prescribed to treat other conditions. For instance, prescribed medications to relieve cold symptoms may be covered by Part D if they're prescribed to treat something other than a cold (e.g., shortness of breath from severe asthma). These drugs also must be approved by the FDA for such treatment.

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