What Medicare Part D Drug Plans Cover
Medicare Part D helps cover the cost of prescription medications. Plans are offered by private insurers approved by Medicare and must follow federal rules.
Formularies (List of Covered Drugs)
- Every Part D plan has a formulary (its covered drug list).
- Plans must include a broad mix of drugs in each therapeutic class.
- Formularies can change yearly — review during Open Enrollment.
Tiers of Coverage
Higher tiers generally mean higher copays or coinsurance.
Generic & Brand-Name Drugs
- Generics work the same as brands and usually cost less.
- Brand-name drugs are covered but often at higher cost-sharing.
What’s Not Covered
- Over-the-counter (OTC) medications
- Cosmetic/lifestyle drugs (e.g., hair growth, weight loss)
- Most prescription vitamins/minerals (limited exceptions)
Tip: Coverage and costs vary by plan. Check that your prescriptions are covered and at which tier before enrolling. Review annually during Open Enrollment.
Important Update: Part D plans cap covered insulin at $35 for a one-month supply (effective 2023 and ongoing). For insulin used via a traditional pump under Part B, the cap also applies.
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