Medicare Part D Exclusion Drug List
The following drugs or drug classes are excluded by Medicare Part D. For dually eligible members (members who are eligible for both Medicare Part D and MassHealth), MassHealth may pay for some of these drugs or drug classes, subject to the prior-authorization requirements listed on the MassHealth Drug List.
Over-the-counter (OTC) Drugs
Except for insulin and supplies associated with the injection of insulin, OTC drugs are excluded by Medicare Part D. OTC drugs that are covered by MassHealth can be found on the MassHealth Nonlegend (OTC) Drug List at www.mass.gov/druglist.
Prescription Vitamins and Minerals
Except for prenatal vitamins, fluoride-containing products, prescription vitamins and minerals are excluded by Medicare Part D. Prescription vitamins that are covered by MassHealth are listed on the MassHealth Drug List.
Some drugs used for weight gain may be excluded by Medicare Part D plans. MassHealth will cover these products only if they are denied by the Medicare Part D plan. Prior-authorization requirements for these drugs can be found on the MassHealth Drug List.
Medicare Part B
There has been no change to Medicare Part B. Products that were covered under Medicare Part B before January 1, 2006, continue to be covered under Medicare Part B. MassHealth continues to act as secondary payer for these services. Prior authorization for drugs covered under Medicare Part B can be found on the MassHealth Drug List.
Last updated 04/19/21