Frequently Asked Questions about Coverage of Specific Drugs

00173056504Yes.  Medicare Part D prescription drug plans do cover the shingles vaccine (stand-alone Medicare Part D plans and Medicare Advantage plans that include drug coverage).  However, . . .

Although Ambien, was covered by many Medicare Part D carriers in prior years, it is currently covered by only a few Medicare Advantage plans (MAPD) and no prescription drug plans (PDP). Instead . . .

Yes. More than 30% Medicare prescription drug plans offer insulin at a maximum co-pay of $35 or less per month throughout the initial deductible, initial coverage, and the Donut Hole. But the $35 coverage depends on the plan and the specific type of insulin.

A few 2022 Medicare Advantage plans cover both Fioricet with Codeine and Fioricet without Codeine, however no stand-alone Medicare Part D plans cover Fioricet with or without Codeine. For example, . . .

Yes, the cost-sharing for any Medicare Part D prescription drug might vary depending on the chosen Medicare prescription drug plan and pharmacy. For example, if we are looking at stand-alone 2015 M . . .

Yes, "when [these medications are] used to treat epilepsy, cancer, or a chronic mental health disorder". A certain group of prescription medications are specifically excluded from Medicare Part D p . . .

Maybe.  Depending on the ingredients of the compounded drug there may be at least partial brand-name or generic drug coverage.  For more information about coverage of compounded drugs, plea . . .

Starting back in 2019, your Medicare Part D plan (MAPD or PDP) implemented a drug management program (or drug utilization management) to monitor and limit "at-risk" Medicare beneficiaries’ acces . . .

Niaspan® is no longer covered by many Medicare Part D prescription drug plans. To see the which Medicare prescription drug plans in your area that are now covering Niaspan, you can use our Dru . . .

As part of the CMS "Part D Senior Savings Model" (Model), about 30% of all stand-alone Medicare Part D plans (PDPs) and Medicare Advantage plans with drug coverage (MAPDs) will offer coverage of diffe . . .

To learn more about low-cost insulin coverage, you can:Contact the Medicare drug plan's Member Services Department,Review the drug plan's Evidence of Coverage document,Speak with a Medicare representa . . .

No. The 75% Donut Hole discount, does not apply to Medicare Part D excluded drugs even if they are covered by the Medicare Part D prescription drug plan as a “Bonus Drug” (also known as &# . . .

Bonus or Supplemental drugs are medications specifically excluded from the Medicare Part D program - although they are covered by your Medicare drug plan (as a "bonus").Since these drugs are not cover . . .

No.  Medicare changed positions on this policy and first provided Donut Hole discounts for compounded Medicare Part D drugs in May 2010: "Part D sponsors shall only provide a discount on a compo . . .

The Centers for Medicare and Medicaid Service (CMS) defines a Medicare Part D covered drug as:"A Part D covered drug is available only by prescription, approved by the FDA (or is a drug described unde . . .

As noted by the United States Food and Drug Administration (FDA): "The term “authorized generic” drug is most commonly used to describe an approved, brand name drug that is marketed a . . .

A few 2022 Medicare Advantage plans cover both Fioricet with Codeine and Fioricet without Codeine, however no stand-alone Medicare Part D plans cover Fioricet with or without Codeine. For example, . . .

As part of the CMS "Part D Senior Savings Model" (Model), about 30% of all stand-alone Medicare Part D plans (PDPs) and Medicare Advantage plans with drug coverage (MAPDs) will offer coverage of diffe . . .

To learn more about low-cost insulin coverage, you can:Contact the Medicare drug plan's Member Services Department,Review the drug plan's Evidence of Coverage document,Speak with a Medicare representa . . .

Yes. More than 30% Medicare prescription drug plans offer insulin at a maximum co-pay of $35 or less per month throughout the initial deductible, initial coverage, and the Donut Hole. But the $35 coverage depends on the plan and the specific type of insulin.

Niaspan® is no longer covered by many Medicare Part D prescription drug plans. To see the which Medicare prescription drug plans in your area that are now covering Niaspan, you can use our Dru . . .

Maybe.  Depending on the ingredients of the compounded drug there may be at least partial brand-name or generic drug coverage.  For more information about coverage of compounded drugs, plea . . .

No.  Medicare changed positions on this policy and first provided Donut Hole discounts for compounded Medicare Part D drugs in May 2010: "Part D sponsors shall only provide a discount on a compo . . .

Starting back in 2019, your Medicare Part D plan (MAPD or PDP) implemented a drug management program (or drug utilization management) to monitor and limit "at-risk" Medicare beneficiaries’ acces . . .

The Centers for Medicare and Medicaid Service (CMS) defines a Medicare Part D covered drug as:"A Part D covered drug is available only by prescription, approved by the FDA (or is a drug described unde . . .

Bonus or Supplemental drugs are medications specifically excluded from the Medicare Part D program - although they are covered by your Medicare drug plan (as a "bonus").Since these drugs are not cover . . .

Yes, the cost-sharing for any Medicare Part D prescription drug might vary depending on the chosen Medicare prescription drug plan and pharmacy. For example, if we are looking at stand-alone 2015 M . . .

Although Ambien, was covered by many Medicare Part D carriers in prior years, it is currently covered by only a few Medicare Advantage plans (MAPD) and no prescription drug plans (PDP). Instead . . .

As noted by the United States Food and Drug Administration (FDA): "The term “authorized generic” drug is most commonly used to describe an approved, brand name drug that is marketed a . . .

Yes, "when [these medications are] used to treat epilepsy, cancer, or a chronic mental health disorder". A certain group of prescription medications are specifically excluded from Medicare Part D p . . .

No. The 75% Donut Hole discount, does not apply to Medicare Part D excluded drugs even if they are covered by the Medicare Part D prescription drug plan as a “Bonus Drug” (also known as &# . . .

00173056504Yes.  Medicare Part D prescription drug plans do cover the shingles vaccine (stand-alone Medicare Part D plans and Medicare Advantage plans that include drug coverage).  However, . . .