Aren't Part D plans supposed to cover all medications?

Part D plans and formularies

All Medicare Part D plans create their own formularies, a list of medications they cover or do not cover. There is no such thing as a "standard" formulary.  Each plan's formulary is unique. The goal of choosing a plan is to align your specific medication needs with the plan that best covers your meds.

Contrary to popular belief, Part D plans do NOT have to cover all medications. 

• According to Medicare rules, Medicare Part D plans must include "substantially all" drugs in six protected categories and classes. (No clear definition of what "substantially all" actually means.)
  • Anticonvulsants: Drugs to treat seizures and other seizure disorders. 
  • Antidepressants: Medications for depression and other mental health conditions. 
  • Antineoplastics: Cancer medications. 
  • Antipsychotics: Drugs for mental illnesses such as schizophrenia. 
  • Antiretrovirals: Medications used to treat HIV/AIDS. 
  • Immunosuppressants: Drugs to prevent organ transplant rejection.
    
    
• Outside of those six protected categories and classes, the rule is that Medicare Part D plans must cover at least two drugs in the most commonly prescribed categories and classes.
  • At least two drugs can mean just two drugs
  • The most commonly prescribed categories and classes does NOT mean all categories and classes.

This means Medicare Part D plans may not cover any medications in the categories and classes not considered to be the most commonly prescribed.

Plans can and do change the medications they cover each year.  Medications covered by a plan this year may not be covered by the same plan next year.

When your plan does not include a medication, consider alternatives.

Most medications have competitive or similar options.  For example, Atorvastatin (for cholesterol), people could try Rosuvastatin, Simvastatin, Pravastatin and others.  If your version of a medication is not covered, talk to your doctor about an alternative.