What’s on the List of Drugs Covered by Medicare Part D?

Medicare Part D is a federal program that helps cover the cost of prescription drugs for Medicare beneficiaries. Established in 2006, this plan has evolved significantly, especially in 2025 with the continued implementation of the Inflation Reduction Act. Medicare Part D is optional, but many seniors choose to enroll because of the substantial savings it offers on essential medications. Prescription drug plans under Part D are provided by private insurance companies approved by Medicare. These companies offer various plans with different costs and covered medications. Understanding the list of drugs covered by Medicare Part D is essential for managing both your health and your budget.

In 2025, Medicare has made several reforms to improve affordability and transparency, making it even more crucial to stay informed about your plan’s coverage.

Importance of the Medicare Part D Formulary

The formulary is the heart of any Medicare Part D plan. This is the official list of prescription medications that the plan covers. The list is carefully curated based on medical effectiveness, safety, and cost-efficiency. Formularies are updated annually, and knowing what’s included in 2025 will help you choose the best plan for your needs.

Not every drug is included in every formulary. Each insurance company offering Part D must cover a wide range of drugs across therapeutic classes, but they have flexibility in the specific drugs they choose to cover.

What Determines Which Drugs Are Covered?

The Centers for Medicare & Medicaid Services (CMS) requires that every Part D plan cover at least two drugs in each category and class of medications. However, beyond that baseline, plans can choose which specific drugs to include.

Tier Levels of Prescription Drug Plans

Medications are placed in tiers, which help determine how much you pay:

• Tier 1: Preferred generics (lowest copay)

• Tier 2: Non-preferred generics

• Tier 3: Preferred brand-name drugs

• Tier 4: Non-preferred brand-name drugs

• Tier 5: Specialty medications (highest cost)

Formularies and Their Role

Insurance providers have Pharmacy & Therapeutics (P&T) Committees to determine their formulary lists. These committees use evidence-based research to decide on which medications make it into their plans, ensuring a balance between clinical effectiveness and cost containment.

Common Drug Categories Covered Under Medicare Part D

Medicare Part D plans are mandated to cover certain essential medication categories. In 2025, the following categories remain protected:

Antidepressants and Antipsychotics

These are crucial for mental health and are covered broadly by Part D plans. Drugs such as fluoxetine, sertraline, and aripiprazole are commonly found in formularies.

Immunosuppressants and Cancer Medications

These drugs, vital for organ transplant recipients and cancer patients, are usually covered, including medications like tacrolimus, letrozole, and tamoxifen.

HIV/AIDS Drugs and Antivirals

Life-saving antiretrovirals and antivirals such as Truvada and valacyclovir are often included due to their importance in managing long-term conditions.

Vaccines and Preventive Medications

Medicare Part D now covers more vaccines than ever before in 2025, including shingles, Tdap, and RSV vaccines without cost-sharing, thanks to recent legislative changes.

Drugs Commonly Covered in 2025

Generic Drugs on Part D Plans

Generic medications are usually found in Tier 1 or Tier 2, making them the most affordable option for most beneficiaries. Common generics include:

• Metformin (diabetes)

• Lisinopril (blood pressure)

• Atorvastatin (cholesterol)

• Omeprazole (acid reflux)

Brand Name Drugs Covered by Medicare Part D

Some high-cost brand-name drugs that are typically covered include:

• Eliquis (blood thinner)

• Jardiance (type 2 diabetes)

• Xarelto (blood clots)

• Advair (asthma/COPD)

While these drugs are usually in Tier 3 or 4, they may be included in preferred drug lists if negotiated discounts are in place.

Medications NOT Covered Under Medicare Part D

Excluded Drugs and Why They’re Not Included

Certain medications are excluded by law from Medicare Part D coverage. These include:

• Drugs for anorexia or weight gain

• Fertility medications

• Cosmetic drugs (e.g., hair growth treatments)

• Erectile dysfunction medications

These drugs do not meet the “medically necessary” criteria defined by CMS and, therefore, are not eligible for coverage.

Over-the-Counter Medications

OTC medications like ibuprofen or antacids are not covered, even though they are widely used. However, some Medicare Advantage plans may include limited OTC benefits.

How to Check If Your Drug Is Covered

You can verify coverage using the Medicare Plan Finder tool on Medicare.gov. This tool lets you input your prescriptions and compare available Part D plans based on coverage and out-of-pocket costs.

How Drug Tiers Impact Your Costs

The tier your medication falls into significantly affects how much you’ll pay. In 2025, new rules cap out-of-pocket spending, but costs can still vary widely based on tier. Ask your doctor if a lower-tier alternative might be just as effective.

Call the official Medicare helpline at 1-800-MEDICARE (1-800-633-4227) to ask your questions or get more information.

Changes to Part D Coverage in 2025

Inflation Reduction Act and Its Impact

One of the biggest changes in 2025 is a $2,000 out-of-pocket spending cap for prescription drugs, drastically reducing financial burden for those with chronic conditions. This is a result of the Inflation Reduction Act, which also gives Medicare new power to negotiate drug prices.

2025 Out-of-Pocket Spending Caps

• No more catastrophic coverage phase

• No cost-sharing for certain vaccines

• Better access to insulin at reduced prices ($35/month cap)

These enhancements offer tremendous relief for seniors struggling with expensive medications.

Cost-Saving Strategies for Medicare Part D Users

• Use mail-order pharmacies

• Opt for preferred generics

• Apply for Extra Help if you qualify (low-income subsidy)

• Review your plan during open enrollment

What to Do If Your Medication Isn’t Covered

• Request a formulary exception

• Ask your doctor for alternatives

• Use state pharmaceutical assistance programs (SPAPs)

• Consider switching plans during the Annual Election Period (Oct 15 – Dec 7)

Best Practices for Choosing a Part D Plan

• Check coverage for your medications

• Compare premiums, deductibles, and copays

• Review the plan’s network of pharmacies

• Use online tools like the Medicare Plan Finder

Frequently Asked Questions (FAQs)

What drugs are covered on Medicare Part D?
Part D covers a wide range of prescription drugs, including generics, brand names, and essential medications across categories like heart disease, diabetes, mental health, and cancer.

Which medication would not be covered under Medicare Part D?
Medications for weight loss, fertility, or cosmetic use are generally not covered under Medicare Part D.

What are the disadvantages of Medicare Part D?
Potential disadvantages include plan complexity, varying formularies, tiered pricing, and uncovered medications.

Which item will Medicare Part D not cover?
Items like over-the-counter drugs, vitamins, and cosmetic treatments are not covered under Part D.

Can I appeal a drug coverage denial?
Yes, you can request an exception or appeal if your needed drug is not covered by your plan.

Are vaccines covered under Part D in 2025?
Yes, many vaccines, including shingles and Tdap, are fully covered without cost-sharing.

Final Thoughts

Navigating the list of drugs covered by Medicare Part D in 2025 can feel overwhelming, but understanding the tiers, exclusions, and recent legislative updates makes a big difference. With new spending caps and more power to negotiate drug prices, 2025 brings encouraging changes for Medicare beneficiaries.

Always review your plan annually and use tools like the Medicare Plan Finder to ensure your prescriptions are covered at the best possible cost. By staying informed and proactive, you can get the medications you need without breaking your budget.

Turn 65 with confidence—get your free Medicare quote now at NewMedicare.com or call 📞 (833) 203-6742.