PDP Plan

Medicare allows you to enroll in a stand-alone prescription drug plan during certain times of the year or when special circumstances occur. Learn more about enrolling in prescription drug coverage by reviewing Enrollment Periods Available and their Requirements. 

When selecting a Medicare Part D Plan, please consider the following:

  • How often you use prescription drugs
  • The types of drugs you take (generic, brand name, or a combination of both)
  • Whether you prefer Medicare Part D drug plans with a yearly deductible, or you’d rather have a $0 deductible plan with higher cost-sharing or a higher monthly premium
  • How copays and coinsurance amounts differ between preferred and standard pharmacy networks and within each of the four Part D coverage stages
  • Out-of-pocket copays and coinsurance amounts that go into effect should you enter the Coverage Gap (Donut Hole)

Drugs Not Covered by Exemplar Health Medicare Part D Formulary

Federal law prohibits your Medicare Part D prescription drug plan from covering certain types of drugs, including:

  • Non-prescription drugs (also called over-the-counter drugs).
  • Drugs when used for treatment of anorexia, weight loss or weight gain.
  • Drugs when used to promote fertility.
  • Drugs when used for cosmetic or hair growth purposes.
  • Drugs when used for the relief of cough or cold symptoms.
  • Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations).
  • Drugs when used for the treatment of sexual or erectile dysfunction (ED).
  • Covered outpatient drugs which the manufacturers seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee.

Remember also, Medicare Part D prescription drug plans are unable to cover the following:

  • Drugs that would be covered under Medicare Part A or Part B. Some drugs are covered under Medicare Part B in certain cases and under Medicare Part D in others. In most cases, your pharmacist or provider will provide information to your plan to appropriately determine whether to bill Medicare Part B or Part D for your drug.
  • Drugs not approved by the U.S. Food and Drug Administration (FDA) or that are purchased outside the United States and its territories.
  • Off-label use, in many cases, where a drug is used in any way other than those indicated on a drug’s label as approved by the Food and Drug Administration. (Generally, coverage for “off-label use” is allowed only when use is supported by certain references.)
  • If you’re ready, you can Enroll Now

Last Updated on September 30, 2020 by marketing