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Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan (for those enrolled in Original Medicare) or as a set of benefits included with your Medicare Advantage Plan.
Unless you have creditable drug coverage and have a Special Enrollment Period, you should enroll in Part D when you first get Medicare. If you delay enrollment, you may face gaps in coverage and enrollment penalties.
Each Part D Plan has a list of covered drugs, called its formulary. If your drug is not on the formulary, you may have to request an exception, pay out of pocket, or file an appeal.
A drug category is a group of drugs that treat the same symptoms or have similar effects on the body. All Part D Plans must include at least two drugs from most categories and must cover all drugs available in the following categories:
Some drugs are explicitly excluded from Medicare coverage by law, including drugs used to treat weight loss or gain, and over-the-counter drugs.
Note: Certain drugs, or under specific circumstances, may be covered by Part A or Part B.