Which drugs must all plans cover?

December 5, 2014

Medicare wants to be sure that people are able to get their drugs, especially if stopping or changing drugs could cause health problems. The Medicare Prescription Drug Plans must have “all or substantially all” of drugs in the following six categories:

  • Anticonvulsants used to treat epilepsy and other conditions, including mental health conditions
  • Antidepressants
  • Antipsychotics
  • Anti-cancer
  • Immunosuppressant drugs
  • HIV/AIDS drugs

The plans may put these drugs on different tiers or levels and have different copays.

Medicare has made these specific statements:

  • Iressa and Fosphenytoin – They do not have to be included in the plan’s drug list.
  • Fuzeon – Plans can ask new users to get prior authorization, which means the plans must approve their drug before they buy it.
  • A plan’s drug list must have either escitalopram or citalopram.