Table of Contents

Getting Started - The Basics

About Enrolling

Costs and Coverage

Problems Getting Your Drugs Under Your Plan

Other Common Problems / Changing Plans

Health Care Reform and Part D

Information for Medicare Providers

Will Part D pay for all of my prescriptions?

Not necessarily.

Certain types of drugs are not covered by Part D (the"excluded" drugs), including:

• Over-the-counter drugs, with the exception of insulin;
• Weight-loss and weight-gain drugs;
• Drugs to relieve cough/cold symptoms;
• Drugs to promote hair growth;
• Fertility drugs;
• Prescription vitamins, with the exception of prenatal vitamins and fluoride;
• Cosmetic drugs;
• Drugs that must be monitored by testing services that only the manufacturer provides, such as certain anti-psychotics
• Barbituates; and
• Benzodiazapines.
• Beginning in 2007, drugs used to treat erectile dysfunction are excluded from Part D. These drugs may be covered by Part D if used to treat other conditions, such as pulmonary hypertension.

NOTE: If you are a member of MaineCare, the Medicare Savings Program, or the Drugs for the Elderly program (DEL), those programs may pay for some of the drugs listed above. Be sure your pharmacist knows you are in MaineCare, the Medicare Savings program and/or DEL.

In addition, some drugs are covered by Medicare Part B and are therefore not covered by Medicare Part D. In that case, your pharmacist should bill Medicare Part B. Also, some medications are not considered Medicare Part D drugs because they do not have FDA approval at all, or do not have FDA approval for a particular use and that use is not supported by certain medical compendia.

Even if your drugs are Part D medications, your prescriptions may not be covered by your particular Part D plan.  This is because each Part D plan has a unique list of drugs it will cover. A Part D plan’s drug list is known as a "formulary." If your drug is on your Part D plan’s formulary, that Plan may have restrictions on it, such as quantity limits, "step therapy" requirements, or a requirement that your doctor obtain Prior Authorization.

To find out which Part D plan's formulary will best meet your prescription needs, go to the Medicare website Formulary Finder,

OR

Call your local Area Agency on Aging at 1-877-353-3771, or TTY: 1-800-750-5353.

NOTE: If you cannot find a plan that covers all of your drugs, you may be able to enroll in a plan and request an "Exception" (Coverage Determination) to obtain full coverage. For more information, see our Exceptions (Coverage Determination) page