What if Medicare doesn’t cover a drug I need?
Generally, Medicare Part B covers drugs administered and billed by a doctor or other prescriber. Medications that are dispensed by prescription and usually self-administered are generally covered by Medicare Part D drug coverage. If a drug is not covered by your Part D plan, your plan may allow you a one-time, temporary supply during your first 90 days of your membership, called a ‘transition supply.’
A transition supply gives you and your doctor or other prescriber time to find another drug covered by your plan that will treat your condition. If your doctor or other prescriber decides you need a certain drug (or that a drug requirement be waived) due to your medical condition, your doctor or other prescriber can request a Coverage Exception. If the plan approves the request, it will cover the drug. If not, you may file an Appeal asking your plan to reconsider its decision.
Note: Transition supplies for people who move into or already live in a nursing home or long-term care facility may be different. See your plan’s Evidence of Coverage for more information.
Return to the Medicare FAQ section to view more answers to other commonly asked questions about Medicare prescription drug coverage.