01-19-2021 Your prescriptions

Medications Not Covered by Medicare

Medications Not Covered by Medicare

The cost of prescription drugs can be astronomical. Certain recurring prescriptions can cost more than the average American household earns in a month.1 Fortunately, many Americans don’t have to pay out of pocket because their insurance, or other coverage like Medicare, covers all or a portion of the prescription cost. Although Medicare covers many prescription drugs, there are a number of medications that are not covered. As you may already know, Medicare consists of Part A and Part B. In a nutshell, Part A pertains to hospital insurance, meaning you are only covered for the medications used during your stay in the hospital. Part B refers to medical insurance, meaning you are covered for prescription drugs prescribed by your doctor or an outpatient clinic.

Which Medications are Not Covered by Medicare?

Additionally, there is also Part D, which is additional coverage you purchase through private companies. Part D is commonly referred to as the Medicare prescription drug program. Even with Part D, Medicare doesn’t cover all medications. If you are prescribed a medication that is not covered, it can be quite expensive. To prevent costly surprises, here is a list of the some medications that are often not covered:2

  • Drugs for fertility (i.e., Ovidrel®, Follistim®, Gonal-f, Clomid, etc.)
  • Anorexia, weight gain, or weight loss drugs (i.e., phentermine HCI, Xenical®, Meridia, etc.)
  • Drugs for cold or cough symptoms (i.e., Robitussin® AC, Phenergan, Tanafed, etc.)
  • Drugs for cosmetic purposes (i.e., Renova®, Vaniqa®, Propecia®, etc.)
  • Drugs for sexual dysfunction (i.e., Cialis®, Viagra®, Levitra®, Muse®, etc.)
  • Over-the-counter prescription drugs
  • Vitamins and minerals (except for prenatal vitamins and fluoride preparations)
  • Drug efficacy study implementation (DESI) drugs (FDA had seemed safe but not effective)
  • Drugs that are non-FDA approved

In addition to the medications just listed, devices (i.e., diaphragms), line flush (i.e., saline IV flush), and medical supplies are also not covered.

If you have been prescribed one of these medications, don’t worry – there are options, so you don’t have to pay full price. One option is to ask for an exception and request that your prescription be covered. To do so, you will need a written letter from your doctor to assist with this process. If it is denied, there are 5 levels of appeal available to you. The downside to this option is that it can be a lengthy process, and if you need your medication immediately or urgently, you will have to pay out of pocket and hope that you are reimbursed if granted the exception. With the price of many medications being so high, it’s possible paying full price isn’t an option. Fortunately, there is a way to get your prescription up to 80% less.

How to Save Up to 80% on Prescription Medications

Many people don’t realize that there are discounts available for medication. Coupons and discount cards, like the free America's Pharmacy Prescription Savings Card, can significantly reduce the price of these medications. You know how there are discount cards for your favorite grocery store or coupons for laundry detergent? It’s the same concept. You and your family (even your pets!) can save up to 80% on medication by simply visiting America’s Pharmacy, finding your medication, choosing a discount, and then showing your pharmacist when you fill your prescription!

SOURCES:

1. https://www.msn.com/en-us/money/insurance/the-20-most-expensive-prescription-drugs-in-2020/ss-BB10wlHz

2. https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-part-d-coverage/drugs-excluded-from-part-d-coverage