Prescription Costs & Part D
What drugs does Medicare Part D not cover?
Last reviewed: · Big Sioux Benefits Data Desk
Federal law excludes several categories of drugs from Part D entirely, no matter which plan you choose. The statutory exclusions include drugs used for weight loss or weight gain, fertility drugs, drugs for cosmetic purposes such as hair growth, over-the-counter drugs, and most drugs used for erectile dysfunction. A plan cannot cover these under its basic Part D benefit even if it wanted to.
The qualifier: there are two separate layers here, and people conflate them. The first is the statutory exclusion list above, which applies everywhere. The second is your individual plan's formulary, which is the list of drugs that particular plan chose to cover. A drug can be perfectly eligible for Part D coverage and still be absent from your plan's formulary, which is a different problem with a different solution.
Two different reasons a drug is not covered
| Statutory exclusion | Not on your plan's formulary | |
|---|---|---|
| Applies to | Every Part D plan in the country | Your specific plan only |
| Examples | Weight-loss drugs, fertility drugs, most ED drugs, OTC medicines | A covered-eligible brand your plan left off its list |
| Can you appeal? | No, the exclusion is in the law | Yes, through a formulary exception request |
| Realistic options | Pay cash, manufacturer assistance, or a different drug | Exception request, a different plan next year, or a covered alternative |
One important nuance on the weight-loss exclusion: the same drug can be covered when prescribed for a different, covered indication. That distinction drives most of the confusion around GLP-1 medications, which is worked through in does Medicare cover weight-loss drugs. Some drugs are also excluded from Part D because they belong under Part B instead, which is covered in Part B versus Part D drugs.
Sources
- Medicare.gov — What Medicare Part D drug plans cover — accessed 2026-08-21
- Medicare.gov — Costs for Medicare drug coverage — accessed 2026-08-21
Related questions
If Part D will not cover my drug, can I appeal?
It depends which reason applies. If the drug is statutorily excluded, no appeal will change that, because the exclusion is written into federal law. If the drug is Part D eligible but simply not on your plan's formulary, you can request a formulary exception, and your prescriber's clinical justification is the deciding factor.
Does Part D cover over-the-counter drugs?
No. Over-the-counter drugs are excluded from the Part D benefit. Some Medicare Advantage plans offer a separate over-the-counter allowance as an extra benefit, but that is a plan perk rather than Part D coverage, and it does not count toward your Part D out-of-pocket total.
Drug costs turn on your specific prescriptions, so the arithmetic is worth doing once, properly: book a free, no-pressure conversation, see your county's South Dakota plan lineup, or browse all answers. SHIINE, the state's free counseling program, is at 1-800-536-8197 and sells nothing.
Big Sioux Benefits is a licensed insurance agency, not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Contact Medicare.gov, 1-800-MEDICARE, or SHIINE (South Dakota's SHIP) for all of your options.