Prescription Drug Exclusions

What is an exclusion?

By law, certain types of drugs or categories of drugs are not covered by Medicare Prescription Drug Plans. These drugs are not considered Part D drugs and may be referred to as “exclusions” or “non-Part D drugs.” 

These drugs include:

• Nonprescription drugs
• Drugs, when used for anorexia, weight loss or weight gain
• Drugs, when used to promote fertility
• Drugs, when used for cosmetic purposes or hair growth
• Drugs, when used for the symptomatic relief of coughs or colds
• Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
• Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale
• Drugs, when used for the treatment of sexual or erectile dysfunction

In addition, a Medicare Prescription Drug Plan cannot cover a drug that would be covered under Medicare Part A or Part B.

Off-Label Use

Also, while a Medicare Prescription Drug Plan can cover off-label uses of a prescription drug, we cover the off-label use only in cases where certain reference book citations support the use. Congress specifically listed the reference books that list whether the off-label use would be permitted. These are:

1. American Hospital Formulary Service Drug Information.
2. United States Pharmacopoeia-Drug Information.
3. The DRUGDEX Information System.
4. Medscape

If the use is not supported by one of these reference books (known as compendia), then the drug would be considered a non-Part D drug and would not be covered by Elderplan.
Learn More About Elderplan Prescription Drugs Plan.