Medicare Part D Formulary Exclusions

There are millions of medications that are used to treat a variety of illnesses. There are some medications that are very commonly prescribed and others that are very unusual. When people are prescribed a medication, they don't always expect their Medicare part D prescription drug plan not to pay for it. There are a lot of people that are surprised there are exclusions on their Medicare part D formulary.

The insurer that offers a Medicare part D prescription drug plan has to follow certain boundaries. These boundaries and regulations are established by Medicare and regulated by the Centers for Medicaid and Medicare Services. Medicare has specific medications they have determined they will not allow to be put on their formularies. There are many different reasons to why this happens but once a medication is on that list, only Medicare can reverse that decision to make it available for all.

What are some of the medications excluded?

On a Medicare part D formulary, there are certain things that a beneficiary can't use their benefits for. These medications can be very beneficial for those that take them but they will have to pay for them without Medicare's assistance. These medications include:

·         over the counter medications (even with a doctor's prescription)

·         fertility drugs

·         medications from a different country

·         most vitamins and minerals

·         medications that covered under Medicare part A or part B

·         cosmetic medications

·         hair growth medications

·         erectile dysfunction medications (when used to treat erectile dysfunction or a sexual disorder)

These are a few of the medications that Medicare beneficiaries find themselves paying retail pricing for. Although the list is extensive, it isn't all inclusive. The largest set of medications that aren't covered by Medicare part D prescription drug plans as of 2012 are benzodiazepines and barbiturates.


Why can't I get my anxiety medications?

There are thousands of people diagnosed with anxiety problems each year. Doctors often prescribe a medication to help keep their patients calm and keep their anxiety under control. Those anxiety medications often fall under the classification of a benzodiazepine or a barbiturate. These are two classes of medication that have been excluded from Medicare part D's formulary for years.

Benzodiazepines are medications that are commonly prescribed to treat anxiety that people experience. With it being a central nervous system depressant, it can also be used to relieve muscle spasms, symptoms of alcohol withdrawal or even a panic disorder. This is a medication that is very helpful to those that take it however it is a class that is not covered by Medicare part D formularies.

Barbiturates are also considered a depressant to the central nervous system. These medications are sometimes used as a way to treat anxiety, insomnia and agitation. There are some cases that this was used when people were put to death by lethal injection as well as an anesthetic. The effects of this medication are powerful but many doctors prefer to use other medications rather than use barbiturates.

There is no denying that anxiety is a disorder that many people need help managing. Doctors that prescribe benzodiazepines and barbiturates do so with the belief that it will help their patients. Because of the growing number of people that take medications in the benzodiazepine family, there has been legislation to include it in the Medicare part D formulary for 2013. Along with that, there is some legislation to include barbiturates that treat epilepsy, cancer or a chronic mental illness for 2013. Those that take barbiturates in 2014 have a chance to have it covered by their part D prescription drug plan.

There are times that a medication on the exclusion list is helpful in treating an illness it wasn't designed for. In many of those instances, the beneficiaries that need these medications can ask for a formulary exception. This exception is something that would allow them to get the medication covered for them because of their medical circumstances. It's not always guaranteed but it's worth the risk of requesting.

As people look through their medications, they often find many of their medications are covered. When there are instances that medications aren't covered, it could be because Medicare has forbidden the medication to be covered on part D formularies. There are many reasons these medications are traditionally put on a Medicare part D formulary but in some instances those decisions can be reversed. Medicare part D formularies are meant to cover the many medications that have been proven to be the best treatments for illnesses.

Sep. 10 12'

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