Does Medicare Cover Prescription Drugs?
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Medicare does cover prescription drugs. Which drugs and how they’re covered depend on your plan choices:
People with Original Medicare buy prescription drug coverage through a stand-alone Medicare Part D plan.
People with Medicare Advantage generally get prescription drug coverage through their Medicare Advantage plan.
In either case, plans’ premiums, out-of-pocket costs, drug coverage and pharmacy networks can differ significantly, so it’s important to compare options with your personal situation in mind.
What prescription drugs does Medicare cover?
There’s no universal list of the drugs Medicare covers. Each stand-alone Medicare Part D plan and Medicare Advantage plan with prescription drug coverage decides whether and how to cover certain prescription drugs (subject to Medicare’s rules). That plan-specific coverage information is found in the formulary.
Formularies are lists of drugs organized into tiers with different copays, coinsurance and/or deductibles. Check where your drugs fall on the formulary to see what you’d owe for your prescriptions. You should also check each plan for restrictions on drug coverage, such as requirements that certain drugs be approved in advance by the insurer.
How to find Medicare Part D formulary information
You can find and review Medicare Part D plans’ formularies while you’re shopping. They’re generally available alongside other plan materials like Summary of Benefits and Evidence of Coverage documents.
The plan finding tool on Medicare.gov and similar search tools from private companies also allow you to enter information about your drugs and pharmacies to calculate your potential costs based on the formulary.
What if my plan doesn’t cover my drug?
If your plan doesn’t cover a needed drug, it’s possible for you and/or your health care provider to request an exception. If you or your provider can demonstrate that it’s medically necessary, the plan might cover the drug or bill you as if the drug were on a less expensive formulary tier.
Medicare will have big changes in 2025. Compare Medicare Part D Plans
What medications does Medicare not pay for?
While Medicare plans can generally choose what drugs they cover and where they fit on plans’ formularies, certain kinds of drugs are excluded by law from Medicare Part D coverage. For example, drugs like Ozempic are excluded from Part D when used for weight loss.
Here are the types of drugs excluded from coverage, according to the Medicare Prescription Drug Benefit Manual:
Drugs used for anorexia, weight loss or weight gain.
Fertility drugs.
Drugs used for cosmetic purposes or hair growth.
Drugs used to relieve cough and cold symptoms, but not the underlying condition.
Prescription vitamins and minerals other than prenatal vitamins and fluoride preparations.
Erectile dysfunction drugs.
Drugs for which the manufacturer requires purchasing its associated tests or monitoring services as part of the sale.
Nonprescription drugs.
Does Medicare Part B pay for prescription drugs?
Most outpatient prescription drugs are covered by Medicare Part D. But Medicare Part B, which covers outpatient (non-hospital) medical care, covers certain outpatient drugs you don’t administer yourself, such as infusions you get in a doctor’s office or in an outpatient department in a hospital.
What you’ll pay for prescriptions
Premiums
Most stand-alone Medicare Part D plans have premiums. Part D plans have an average total monthly premium of $46.50 in 2025, according to CMS.
Medicare Advantage plans with prescription drug coverage include the cost of that coverage in the plan’s premium — you don’t pay separately for Part D benefits.
With either kind of coverage, people with very high income might owe an additional amount known as an income-related monthly adjustment amount (IRMAA).
Out-of-pocket costs
In addition to any premiums, you might also pay out-of-pocket costs such as copays, coinsurance and deductibles. These costs vary depending on the plan, drug and pharmacy where you fill the prescription.
You can enter your information on Medicare.gov to compare what different plans would cost for your specific drugs and pharmacies.
Compare Medicare Part D companies
Get more information below about some of the major Medicare Part D companies. These insurers offer plans in most states, but specifics may vary depending on your location.
