Medicare Part D generally excludes the following categories of medications from coverage
under the federal drug benefit:
- Agents when used for anorexia, weight loss, or weight gain.
- Agents when used to promote fertility
- Agents when used for cosmetic purposes or hair growth.
- Agents when used for the symptomatic relief of cough and colds
- Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
- Nonprescription drugs (Except OTC Insulin)
- Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee as a condition of sale
- Barbiturates
- Benzodiazepines
- Drugs to treat erectile dysfunction or enhancing libido
- Drug Efficacy Study Implementation Program (DESI) drugs are drugs determined by the FDA to be lacking substantial evidence of effectiveness.
A member’s Medica Pharmacy benefits may include coverage for some Part D excluded drugs. Part D members that receive their Medica Part D benefits as a retiree benefit package may have coverage to some of these medications. Dual eligible beneficiaries may have coverage for some excluded drugs except when prohibited by MN State Benefit Exclusions (i.e. infertility treatments, erectile dysfunction treatments, cosmetic treatments, etc).
- Provider Service Center at 1-800-458-5512
- MedImpact - 1-858-790-7100 or call 1-800-788-2949
- Medica Formulary
- Medica Part D Formulary
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