Medicare Part D generally doesn't pay for drugs for weight loss/gain, fertility, cosmetic purposes (like hair growth), or most cough/cold relief, nor for non-prescription (OTC) drugs, except where these have FDA-approved uses for other conditions (like weight loss drugs for diabetes) or are part of a specific Medicare Savings Program. Drugs covered under Part A (hospital) or Part B (medical) are excluded from Part D, and plans have their own formularies (drug lists).
These are the ten drugs for 2026:
Eliquis (generic name: Apixaban) alone racked up $18.3 billion in Medicare spending in 2023, nearly double the next drug, Ozempic. Alongside Xarelto, anticoagulants accounted for over $24 billion in 2023.
Some of the items and services Medicare doesn't cover include:
All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes, like drugs to treat cancer, HIV/AIDS, or depression. A plan's list of covered drugs is called a “formulary,” and each plan has its own formulary.
Medicare Part D prescription plans don't cover medications used for cosmetic purposes, erectile dysfunction, and hair loss. Over-the-counter medications also are not covered. Medications used solely for losing weight are not covered.
If you have Original Medicare, you can join a Medicare drug plan to get Medicare drug coverage. If you join a drug plan, check your plan's drug list (also called a formulary) to find out what outpatient drugs it covers.
Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: Routine physical exams. Cosmetic surgery.
You can use your Medicare card to access medical services, hospital services for public patients, surgical services, prescription medicines, eye tests, pathology tests, imaging and scans.
What are some disadvantages of Medicare?
Both, Humira and Lipitor, are still the leading drugs by lifetime sales worldwide. However, the leading drug in 2023 was Merck's cancer treatment Keytruda, with 25 billion U.S. dollars in global sales.
Medicare drug plans previously had a coverage gap (also called the "donut hole"). The donut hole was a temporary limit on what the drug plan would cover for drugs. Now all Medicare plans include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan.
The out-of-pocket maximum for prescription drugs covered by your plan ($2,100 in 2026). The prescription drug law caps your out-of-pocket drug costs for covered drugs at $2,100 in 2026. This is true for everyone with Medicare drug coverage, even if you don't participate in the Medicare Prescription Payment Plan.
Follow these tips to help save money at the pharmacy
Since its U.S. approval last year, Kyowa Kirin's $4.25 million metachromatic leukodystrophy gene therapy Lenmeldy has been the No. 1 most expensive drug. Lenmeldy overtook CSL's hemophilia B treatment Hemgenix, which carries a list price of $3.5 million and held down the top spot for more than a year.
Medicare does not cover:
medical and hospital services which are not clinically necessary, or surgery solely for cosmetic reasons; ambulance services; and. emergency department administration or facility fees.
Medicare Advantage plans are difficult to budget, and most plans have high out-of-pocket costs. This is the biggest reason they are bad for some people. With Original Medicare and supplemental Medicare insurance, you pay the bulk of your major medical costs upfront through monthly insurance premiums.
We believe everyone has the right to great sight. That's why we bulk bill. Simply present your valid Medicare card and receive a comprehensive eye examination at no out of pocket expense for you.
Drugs that promote fertility (i.e., Clomid, Gonal-f, Ovidrel®, Follistim®, etc.) Drugs for cosmetic purposes or hair growth (i.e., Propecia®, Renova®, Vaniqa®, etc.) Drugs for the relief of cough and cold symptoms (i.e., Phenergan w/Codeine, Robitussin® AC, Tanafed, Tessalon® Perle, etc.)
To avoid the Medicare Levy Surcharge (MLS) in Australia, the primary method for high-income earners is to take out an appropriate private hospital insurance policy that covers you for the entire financial year (July 1 to June 30). This policy must have a low excess (under $750 for singles, $1500 for couples/families), not just 'extras' cover, and be in place before the financial year starts to avoid liability for any gaps, say Nanak Accountants and Qantas Insurance. Alternatively, you might be exempt if your income is below the threshold or you qualify for other specific Medicare levy exemptions, according to the ATO.
Glasses, contact lenses and hearing aids – However Medicare does cover eye tests. Cosmetic surgery – Although Medicare can cover the cost of complications that arise from the cosmetic surgery.
Drug coverage (Part D)
begins you may get a transition fill, a one-time, 30-day supply of a drug you've been taking that your plan either doesn't cover or requires prior authorization/step therapy. Check with your plan to find out their specific coverage rules.
Medicare covers prescription drugs in different ways depending on your care setting and treatment needs. Understanding how coverage works can help you avoid unexpected costs.