Which Medications Are Not Covered by Medicare Part D Plans?
Key takeaways:
Medicare Part D prescription plans don’t cover medications used for cosmetic purposes, erectile dysfunction, and hair loss. Over-the-counter medications also are not covered.
Medications used solely for losing weight are not covered. But certain ones that may aid in weight loss but are used to treat other conditions can be covered. One example is Wegovy (semaglutide). When prescribed to prevent a heart attack, a stroke, or another severe cardiovascular condition in someone with obesity, Wegovy is covered.
If a medication you need is not on your plan’s formulary — and taking a similar medication that’s covered wouldn’t be appropriate for your needs — you can ask for an exception.
Table of contents
Medicare Part D plans cover many medications, medical supplies, and vaccines. But they might not provide every prescription benefit you want or need. These plans don’t cover every medication available in the marketplace, but they serve a lot of people. In 2024, Part D plans provided prescription coverage for 53 million of the 67 million people enrolled in Medicare.
Since 2010, Part D prescription plans have covered a dwindling share of available medications. At the same time, they have increased cost sharing for enrollees and added coverage restrictions. Still, Part D plans must cover most medications in six protected classes, which we’ll discuss later. For now, let’s focus on what your Part D plan won’t cover.
Which medications are not covered by Medicare Part D plans?
Medicare Part D doesn’t cover certain medications, including those used to treat:
Hair loss and other cosmetic issues (except acne, psoriasis, rosacea, and vitiligo treatments)
Weight loss — but medications used to treat other conditions, such as Type 2 diabetes, that can aid in weight loss or reduce the risk of heart attack, stroke, or another severe cardiovascular event, may be covered; one such medication is Wegovy (semaglutide), when prescribed to prevent a heart attack, a stroke, or another severe cardiovascular condition in a person with obesity
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Medicare Part D also doesn’t cover:
Medications not approved by the FDA for sale in the U.S.
Over-the-counter products
Prescription vitamins and minerals (except prenatal vitamins and fluoride products)
How can you lower the cost of medications not covered by Medicare Part D?
You have options to reduce the cost of medications when they are not covered by your Part D plan. Here are some tips for savings:
Talk to your prescriber about alternatives: Ask your prescriber about generics and alternative medications, such as biosimilars for biologics. These may be more affordable. Lower-cost options may include filling a 90-day supply instead of 30 days or getting a higher-dose pill that you can cut in half if appropriate.
Ask for an exception from your prescription plan: Request a formulary exception so your medication can be covered. Your doctor will typically submit a supporting statement explaining that the medication is medically necessary because alternatives would have an adverse effect. Some plans will require that you agree to step therapy. This is a type of prior authorization. It requires you to try a less costly medication on the plan formulary to prove that it’s not effective for you or has adverse effects. Then the “step” to the medication you’re requesting typically can be approved.
Explore cost-saving programs: Patient assistance programs, manufacturer copay cards, and other manufacturer savings programs help people afford specific medications. These programs can reduce out-of-pocket costs to as low as $0 per month for people with and without insurance. Patient assistance programs generally serve the uninsured. Manufacturer copay and savings programs are for those with insurance. (But people with Medicare and Medicaid may be excluded.)
Reconsider your prescription plan during open enrollment: If your plan doesn’t cover your prescription, find a plan that has the medication on its formulary. If your prescription coverage is included in a Medicare Advantage plan, you may need to switch your health plan. The Medicare Plan Finder tool can help you find a Medicare Part D plan that covers the medications you need.
Use GoodRx: You can search GoodRx to compare prices for your prescription at pharmacies near you.
How do Medicare Part D drug exceptions work?
There are two kinds of Part D exceptions that can be requested by the plan enrollee, their prescriber, or a representative:
Formulary exception: This should be requested for medication not on the plan’s formulary. You can also ask to have a requirement or restriction — such as step therapy, a prior authorization, or a quantity limit — for a formulary medication waived.
Tiering exception: This should be requested if you need a medication from a more costly tier on lower cost-sharing terms. An example would be getting a high-cost specialty medication at a more affordable copay or coinsurance.
Which medications are typically covered by Medicare Part D?
Part D plans cover a variety of medically necessary medications. Each formulary must have at least two medications in the most commonly prescribed categories and classes. Your medication may not be included, but typically there will be a similar one on the list.
Medicare Part D has a lower out-of-pocket limit in 2025. Your Medicare Part D out-of-pocket spending stops at $2,000 in 2025, and then your prescription plan pays the full costs of covered medications for the rest of the year.
Need help affording medication costs? You can save on prescriptions by comparing prices at different pharmacies, using manufacturer savings cards, accessing patient assistance programs, choosing a mail-order pharmacy, or using GoodRx.
What to do if your medication isn’t covered. If your insurance won’t cover your medication, ask for an exception, talk to your prescriber about alternatives, check manufacturer discounts, or see if you qualify for a patient assistance program.
All Part D plans must include most medications approved by the FDA in six protected classes:
Antidepressants
Anticonvulsants
Antipsychotics
Cancer medications
HIV and AIDS medications
Immunosuppressants for organ transplants
The bottom line
Medicare Part D formularies include many medications, medical supplies, and vaccines. But they don’t cover everything. Part D plans don’t cover medications that treat erectile dysfunction, cosmetic conditions such as hair loss, and fertility issues. Weight-loss medications also aren’t covered. Some medications that may help you lose weight but are used to treat other conditions — such as heart attack or stroke — can be. If your plan doesn’t cover a medication you need, you can ask for an exception. You also may qualify for savings through a manufacturer discount or patient assistance programs.
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References
Centers for Medicare & Medicaid Services. (2024). Exceptions.
Cubanski, J. (2024). A current snapshot of the Medicare Part D prescription drug benefit. KFF.
Medicare.gov. (n.d.). How do drug plans work? Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). What’s Medicare drug coverage (Part D)? Centers for Medicare & Medicaid Services.
Medicare.gov. (2024). Your guide to Medicare drug coverage. Centers for Medicare & Medicaid Services.
Medicare Interactive. (n.d.). Drugs excluded from Part D coverage.
