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Recognizing the drugs Medicare doesn’t pay for

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By law, Medicare doesn’t pay for certain kinds of drugs. Part D plans aren’t prohibited from covering them; Medicare just doesn’t reimburse their cost. So although a few plans may cover some of these drugs, most plans don’t cover any. The types of excluded drugs are:

 Medicines sold over the counter (not needing a doctor’s prescription)

 Drugs used for anorexia, weight loss, or weight gain

 Drugs used for cosmetic reasons and hair growth

 Drugs used to promote fertility

 Drugs used to treat sexual or erectile dysfunction

 Medicines used to treat cough or cold symptoms

 Prescription vitamins and mineral products

Sometimes Medicare will pay for medications in these categories if they’re used for a “medically acceptable” purpose — for example, cough medicines when prescribed by a doctor to alleviate medical conditions such as asthma, drugs for impotency when prescribed to treat different medical conditions that affect veins and arteries, or antismoking drugs if prescribed by a doctor rather than bought over the counter.

Until 2013, Medicare also excluded barbiturates (used for anxiety and seizures) and benzodiazepines (used for anxiety and sleeping problems) because these drugs are often abused. But the ban has now been lifted wholly on both types of drugs, allowing Part D plans to cover them for any medically accepted indication.

Medicare For Dummies

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