Why Your Inhaler Might Not Be Covered Under Medicare Part D (and What HeyMOE Does About It)

HeyMOE Tip:
If you see “Not covered” next to an inhaler in your results, that doesn’t mean you’re out of luck — it means we’ve already run every possible coverage scenario looking for cost effective coverage and found that this particular medication is the cheapest one to exclude. 

Let’s Be Honest: Inhalers Are a Mess

Figuring out the best and lowest-cost Medicare Part D coverage is already complicated. Add inhalers to the mix, and things can get — well — a bit wheezy.

Inhalers are among the most inconsistently covered prescription drugs under Medicare Part D. Even when two inhalers contain the same active ingredients, some plans treat them like entirely different (and far more expensive) medications.

Why This Happens

Several factors make inhalers unusually tricky:

• They’re brand-name heavy.
  Unlike tablets or capsules, there are very few generic inhalers available. Plans can choose to cover one brand and exclude another — even if they’re nearly identical medically.

• Each plan builds its own “formulary.”
  Insurers decide which inhalers to include and at what cost tier. That means an inhaler fully covered on one plan might be completely uncovered on another.

• Formulary space is limited.
  Plans often restrict how many high-cost respiratory drugs they’ll cover to keep premiums low.

What HeyMOE Does Automatically

When you enter your medications, HeyMOE’s engine runs through a series of behind-the-scenes checks designed to get you the best coverage at the lowest overall cost.

Here’s what we do automatically:

1. Swap generics ↔ brands where possible.
   We test both the brand and any available generic equivalents to see which combination yields better coverage.

2. Adjust refill quantities.
   Sometimes changing a 90-day supply to 30 days (or vice versa) can make a medication eligible for coverage.

3. Run “what-if” plan simulations.
   We compare thousands of plan options and configurations to find the least-expensive combination of coverage across all your drugs.

Despite all that, sometimes it’s impossible to get every medication covered by a single plan.

When that happens… it’s almost always the inhaler that ends up uncovered.

What To Do If Your Inhaler Isn’t Covered

If HeyMOE’s results show your inhaler is the odd one out, don’t panic — you still have options.

1. Check for alternatives 

   Ask your prescribing doctor if there’s a therapeutically equivalent inhaler that might be on your plan’s formulary.

2. Use a discount card or coupon

   Many brand inhalers offer manufacturer savings programs or coupons that can dramatically cut the cost outside your Part D plan. HeyMOE also checks GoodRx prices and can point you toward potential savings.

3. Talk to your pharmacy

   Pharmacists often know which inhalers are most commonly covered in your area — and may suggest an equivalent option to discuss with your doctor.

4. Re-evaluate next year

   Formularies change annually. HeyMOE automatically re-checks your medications each Medicare Open Enrollment period to see if that stubborn inhaler finally made it back onto the covered list.

In Short

• Inhalers are expensive, brand-dominated, and inconsistently covered under Medicare Part D.

• HeyMOE automatically tests brand/generic options and refill variations to maximize your coverage.

• When coverage still isn’t possible, we’ll flag it and help you explore your next-best savings options.