Medicare Part D

Medicare Part D is a federal health program designed to subsidize the expensive costs of prescription drugs for people on Medicare in the United States. Part D of Medicare went into effect on January 1st, 2006. People can be covered for prescription drug purchases under plans related to Medicare Part D if they are already entitled to benefits from Medical Part A or have existing enrollment in Medicare Part B.

To obtain the drug benefit of Medicare Part D, a beneficiary can sign up from one of two types of private plans: the individual can join a PDP, or a prescription drug plan, that provides drug coverage, or the person can join an MA or medicare advantage plan that provides coverage for both prescription drugs and medical services (this is known as an MA PD). Statistics indicate two thirds of people who benefit from Medicare Part D choose the PDP option. Different drugs may have different levels of coverage, which means participants are often led to choose particular drugs over others. Tiered formulations are typically used which allot less expensive drugs to lower tiers, making them cheaper to purchase and easier to prescribe.

People who are dual eligible s are people who are also eligible for benefits from Medicaid. These people were switched from having their prescription drug coverage come from Medicaid to having it come from a plan on Medicare Part D in 2006. These people now have a cheaper PDP plan in their area that was randomly chosen. The majority of people who can benefit from Medicare must actively enroll in a Medicare Part D plan to receive its benefits. 27 million people are currently enrolled in Medicare Part D.

It is important to note that there are several classes of drugs that are not covered by Medicare Part D. The Food and Drug Administration is the government agency assigned with declaring drugs safe for use in the United States. Until a drug has been approved by the Food and Drug Administration, it will not be covered by Medicare Part D. Similarly, drugs that are prescribed for use off label and drugs that are not available to be prescribed for buying in the U.S. are not covered under Medicare Part D. If a drug can be paid for through either Parts A or B of Medicare, it will not be covered under Part D. Additionally, drugs used for weight loss, weight gain, or anorexia may be excluded from coverage, as may drugs used to treat erectile dysfunction or promote fertility.

Drugs prescribed for cosmetic purposes such as hair growth or hair removal may not be covered. Drugs used to relieve people of symptoms from coughs and colds may not be covered. Barbiturates, benzos, and various prescription vitamins and minerals may not be covered. However, many of these drugs may be included as supplemental benefits under drug plans as long as they would otherwise be covered by the definitions of Medicare Part D drugs. However, if you have a plan that covers one of the excluded drugs described above, the plan will not be able to pass the charges forward to Medicare. If plans are discovered to have billed Medicare to cover such drugs, they will be required to pay CMS back.