Medicare Health Plans >> Drug Exclusions

Medicare Health Plans

Drug Exclusions

A Medicare Prescription Drug Plan can not cover a drug that would be covered under Medicare Part A or Part B.  Also, while a Medicare Prescription Drug Plan can cover off-label uses (meaning for uses other than those indicated on a drug’s label as approved by the Food and Drug Administration) of a prescription drug, we cover the off-label use only in cases where the use is supported by certain reference-book citations.

By law, certain types of drugs or categories of drugs are not normally covered by Medicare Prescription Drug Plans. These drugs are not considered Part D drugs and may be referred to as “exclusions” or “non-Part D drugs.”  These drugs include:

Non-prescription drugs (or over-the counter drugs)	Drugs when used for the treatment of anorexia, weight loss, or weight gain
Drugs when used to promote fertility	Drugs when used for cosmetic purposes or promote hair growth
Drugs when used for the symptomatic relief of cough or colds	Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale	Barbiturates and Benzodiazepines
Drugs such as  Viagra, Cilais, Levitra, and Caverject, when used for the treatment of sexual or erectile dysfunction

 

If you have any questions, please call or write to:

Welborn Health Plans Customer Services
101 S.E. 3rd St
Evansville, IN 47708
(812) 426-6600
Toll Free: 1-800-521-0265
TTY users, call Indiana Relay: 1-800-743-3333
FAX: (716) 541-6386

Pharmacy 24-hour Customer Care:
Phone: 1-888-816-7981
TTY: 1-866-236-1069

 

 

Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply. HMO members must receive all routine care from plan providers. Plans may be renewed annually. Limitations, copayments, and restrictions may apply.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

Updated 10/2010

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