Drugs Not Covered by Medicare 2020

Here are three general rules about drugs that Medicare drug plans will not cover under Part D:

Our plan's Part D drug coverage cannot cover a drug that would be covered under Medicare Part A or Part B.
Our plan cannot cover a drug purchased outside the United States and its territories.
Our plan usually cannot cover off-label use. "Off-label use" is any use of the drug other than those indicated on a drug's label as approved by the Food and Drug Administration.
- Generally, coverage for "off-label use" is allowed only when the use is supported by certain reference books. These reference books are the American Hospital Formulary Service Drug Information, the DRUGDEX Information System, and the USPDI or its successor. If the use is not supported by any of these reference books, then our plan cannot cover its "off-label use."

Also, by law, these categories of drugs are not covered by Medicare drug plans:

Non-prescription drugs (also called over-the-counter drugs)
Drugs when used for treatment of anorexia, weight loss, or weight gain
Drugs when used to promote fertility
Drugs when used for cosmetic purposes or to promote hair growth
Drugs when used for the relief of cough or cold symptoms
Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale
Drugs when used for the treatment of sexual or erectile dysfunction, such as Viagra, Cialis, Levitra, and Caverject
Drugs not registered in the FDA Drug Directory
Brand drugs (i.e. drugs with an FDA application type "NDA" or "BLA") that are not under a manufacturer discount agreement

To learn about your prescription drug benefits and coverage, please review your plan’s formulary. To review, select your plan below:

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