4 Popular Drugs Medicare Will Never Cover

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With many plans and supplements to choose from, enrolling in Medicare can be a daunting task. In particular, it can be difficult to determine whether your essential medications are covered or whether you will instead pay a high price for your prescription drugs. “While health insurance plans do cover most prescription drugs well, we typically see a few drugs that aren’t covered,” says Emilie Gang, the leading expert behind The Medicare Coach. Read on to learn about four drugs that will likely never be covered by Medicare and how to get the most out of your plan despite these glaring gaps in coverage.

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Most major drug categories are covered by one Medicare supplement or another – the key is finding the right coverage for you. However, Gang says compound drugs — those made by combining or mixing two or more drugs to meet the needs of an individual patient — will likely never be covered by Medicare. “That’s because these drugs are generally not FDA-approved and therefore not covered by Medicare Part D drug plans,” Gang said. Better life.

Often, compound drugs are prescribed for people who are allergic to a particular drug ingredient or for those who cannot take a certain drug in its usual form. However, you may be able to discuss possible alternatives with your doctor if these drugs are prohibitively expensive.

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Gang says erectile and sexual dysfunction drugs are another type of drug that Medicare doesn’t cover because it’s not considered a medical necessity.

If you take drugs for sexual dysfunction such as Viagra and Cialis, you may be able to cut costs by asking your doctor or pharmacist for generic versions of these popular drugs, suggests Gang. “It’s worth checking to see if a Medicare drug plan covers these drugs, but it’s often best to use a coupon program, like GoodRX, to get these drugs at affordable prices,” he said. she declared. Better life.

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According to Priority Health, drugs used for cosmetic purposes will also never be covered by Medicare. This category includes drugs used to regrow hair, such as Propecia, or to reduce the appearance of wrinkles, such as Renova.

However, some drugs used to improve skin conditions that may also have cosmetic benefits are covered, so it’s always worth researching. “Drugs used for the treatment of psoriasis, acne, rosacea, or vitiligo are not considered cosmetic drugs and may be covered by Part D,” notes the Medicare Rights Center.

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Although Medicare caters primarily to retirees, some people with disabilities may receive Medicare benefits before age 65. According to a report by the Kaiser Family Foundation (KFF), these people are unlikely to be eligible for fertility assistance unless a doctor deems it medically necessary. .

In particular, in vitro fertilization (IVF) and artificial insemination are excluded from Medicare coverage. “Most patients pay out of pocket for fertility treatments, which can cost upwards of $10,000 depending on the services received,” say KFF experts. “This means that without insurance coverage, fertility care is out of reach for many people.”

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To find out which of your medications are covered by Medicare, Gang recommends reviewing your drug plan’s formulary every year. “The details of the 2023 plan and the formulary will be released on October 1, which is a good time to review your medications,” she notes. “The annual Medicare enrollment period runs from October 15 to December 7, and you can enroll in a new plan for the upcoming calendar year,” adds Gang.

In fact, she says, many people can save significantly on their medications. “Last year, our clients on average saved over $1,000 by reviewing and changing their Medicare drug plans, so don’t miss this opportunity,” she advises.

Best Life offers the most up-to-date information from top experts, new research and health agencies, but our content is not intended to replace professional advice. Regarding any medications you are taking or any other health questions you have, always consult your health care provider directly.

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