EXCLUDED MEDICATIONS

Are there medications that the Medicare prescription drug coverage won’t pay for?

Yes, the list of excluded drugs includes a number of medications that may be used by people with developmental disabilities:

·    Barbiturates

·    Benzodiazepines

·    Prescription vitamin and mineral products (except prenatal vitamins and fluoride preparation)

·    Non prescription drugs

·    Medications used for anorexia, weight loss or weight gain

·    Medications used for cosmetic purposes and hair growth

Will states cover any of the medications excluded from the Medicare prescription coverage?

Many states cover benzodiazepines and barbiturates in their state Medicaid program.  CMS has said that if a state covers these drugs for other Medicaid beneficiaries, the state should cover them for dual eligibles.  Check with the state’s Medicaid office to learn whether it will pay for the dual eligibles to receive the medications that are excluded from Medicare prescription drug coverage or check CMS' "Excluded Drug Coverage Information By State" at: www.cms.hhs.gov/States/EDC/list.asp#TopOfPage 

What are the specific medications in the benzodiazepine class that are excluded from Medicare prescription drug coverage?

Many people do not know the categories of the prescription medications they are taking.  It is helpful to check this list of benzodiazepines because if a dual eligible is taking any of the following medications, they will not be listed on the drug plan formularies:

What are the specific medications in the barbiturate class that are excluded from Medicare prescription drug coverage?