Medicare Part D Exclusion 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, and vitamin D analogs (calcitriol, doxercalciferol, paricalcitol, and dihydrotachysterol), prescription vitamins and minerals are excluded by Medicare Part D. Prescription vitamins that are covered by MassHealth are listed on the MassHealth Drug List.
  
  
• Barbiturates – Barbiturates are excluded from Medicare Part D coverage, unless they are commercially available in combination with one or more drug components not excluded by Medicare Part D (for example, butalbital/acetaminophen/codeine/caffeine).
  • butalbital
  • mephobarbital
  • phenobarbital
  • secobarbital

• Benzodiazepines – Benzodiazepines are excluded from Medicare Part D.  Specific prior- authorization requirement and quantity limits can be found on the MassHealth Drug List.
  • alprazolam
  • clonazepam
  • clorazepate
  • chlordiazepoxide
  • diazepam
  • estazolam
  • flurazepam
  • lorazepam
  • midazolam
  • oxazepam
  • quazapam
  • temazepam

• Miscellaneous – 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.
  • dronabinol
  • megestrol
  • oxandrolone
  • somatropin

• 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.