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 covered by the Medicare Part D prescription drug program, supplemental or bonus drugs do not count toward
meeting any of your Medicare Part D plan limits such as Initial Deductible, Initial Coverage Limit, or total out-of-pocket spending (TrOOP).
Bonus or supplemental drugs may also include over-the-counter (OTC) drugs (that are also not covered by the Medicare Part D program) such as cough or cold medicine.
Bonus drugs may include, such non-Part D drugs as:
- B Complex w/Vitamin C
- Cyanocobalamin (B12) injections or tablets
- Folic Acid
- Multiple Vitamin Injection
- Viagra (or other ED medications)
The Centers for Medicare and Medicaid Services (CMS) defines Medicare
Part D Supplementary (or Excluded) Drugs as: "any drug for which as
prescribed and dispensed or administered to an individual, payments
would be available under Parts A or B of Medicare for that individual,
even though a deductible may apply.
In addition, the definition
of a covered Part D drug specifically excludes drugs or classes of
drugs, or their medical uses, which may be excluded from coverage or
otherwise restricted under Medicaid under section 1927(d)(2) of the Act,
with the exception of smoking cessation agents. The drugs or classes
of drugs that may currently be otherwise restricted under Medicaid
- Agents when used for anorexia, weight loss, or weight gain (even if used for a non-cosmetic purpose (i.e., morbid obesity)).
- Agents when used to promote fertility.
- Agents when used for cosmetic purposes or hair growth.
- Agents when used for the symptomatic relief of cough and colds.
- Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations.
- Nonprescription drugs.
outpatient drugs which the manufacturer seeks to require as a condition
of sale that associated tests or monitoring services be purchased
exclusively from the manufacturer or its designee.
- Agents when
used for the treatment of sexual or erectile dysfunction (ED). ED drugs
will meet the definition of a Part D drug when prescribed for
medically-accepted indications approved by the FDA other than sexual or
erectile dysfunction such as pulmonary hypertension.
ED drugs will not meet the definition of a Part D drug when used
off-label, even when the off-label use is listed in one of the compendia
found in section 1927(g)(1)(B)(i) of the Act: American Hospital
Formulary Service Drug Information, and DRUGDEX® Information System. ED
drugs meet the definition of a Part D drug only when used for
While these drugs or uses are excluded
from basic Part D coverage, Part D sponsors can generally include them
as part of supplemental benefits, provided they otherwise meet the
definition of a Part D drug. Because over-the-counter (OTC) drugs do not
otherwise meet the definition of a Part D drug, they may not be
included as part of supplemental benefits; however, under certain
conditions as part of a plan utilization management program, OTC drugs
can be provided at no cost to enrollees. The cost of these drugs to the
Part D sponsor would be treated as administrative costs under such
(Sources include: CMS Medicare Prescription Drug Benefit Manual, Chapter 6 – Part D Drugs
and Formulary Requirements, Section 30.4 - Transition (Rev. 18, Issued:
01-15-16, Effective: 01-15-16; Implementation: 01-15-16))