What drugs are covered under Medicare prescription drug coverage?

Each plan establishes its own formulary, or list of covered drugs.* Formularies may differ by plan, but are all required to meet certain requirements set by Medicare.

Medicare prescription drug coverage covers drugs that meet the following criteria:

• They must be available only by prescription.
• They must be approved by the Food and Drug Administration.
• They must be used and sold in the United States.
• They must be used for a medically necessary indication.

Specifically, coverage will include:

• Prescription drugs
• Vaccines
• Insulin
• Certain medical supplies associated with the injection of insulin (syringes, needles, alcohol swabs and gauze)

Certain drugs, or classes of drugs, will not be covered because they are excluded by law, such as over-the-counter medicines or drugs used exclusively for weight loss.

Drugs that are covered by our Blue Cross NC Medicare Advantage Prescription Drug (MAPD) plans or our standalone Prescription Drug Plans (PDP), can be found on our formularies.

*Formulary and pharmacy network may change at any time. You will receive notice when necessary.