Only those Medicare Part D plan generic or brand-name drugs treated by your plan as normal formulary drugs (including drugs received by beneficiaries through the formulary exception process) will get the Donut Hole discount.
What type of drugs are often covered by a Medicare plan as Bonus Drugs?
Non-Part D "Bonus" or supplemental drugs may include:
- Vitamins or multi-vitamin injections - B Complex w/Vitamin C, Cyanocobalamin (B12) injections or tablets, Folic Acid
- Levitra
- Mephyton
- Viagra or Cialis (or other ED medications) - Remember that 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 (and can be covered by a Medicare Part D plan).
- Agents when used to promote fertility.
- Agents when used for cosmetic purposes or hair growth.
- Over-the-counter (OTC) drugs (that are also not covered by the Medicare Part D program) such as cough or cold medicine - although these drugs are not part of the Medicare Part D program, plans can make OTC medications available, although not technically supplementary drugs.
Click here to read more about the classes of drugs excluded by the Medicare Part D program.
Reminder about getting coverage for non-formulary drugs:
If you are using a non-formulary medication, you can ask your Medicare plan for a Formulary Exception – a type of Coverage Determination that would add a non-formulary drug to your Medicare Part D plan coverage. (Drugs excluded from the Medicare Part D program are not eligible for a Formulary Exception).
You can click on the following link to read more about Formulary Exceptions and the Formulary Exception process
on this siteIf your Medicare Part D plan denies your request, you have the right to appeal your plan’s decision. For more information, you can click here to read about Formulary Exceptions.
You can click on the following link to learn more about appealing a Formulary Exception denial
on this site