• • About the Part D Benefit
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Coverage

• All Drugs in Certain Categories

  A CMS Memorandum (29Kb PDF file) explains how Part D plans must cover all or substantially all drugs in six categories:

  • HIV/AIDS treatments,
  • Antidepressants,
  • Antipsychotic medications,
  • Anticonvulsive treatments for seizure disorders,
  • Immunosuppressant medications, and
  • Anticancer drugs that are not covered by Medicare Part B.

• Distinguishing Drug Coverage by Medicare Part B vs. Part D

  These CMS documents (45Kb PDF file) explain which drugs are covered by Medicare Part B and which by Part D.

• Getting Prescriptions Filled – Best Available Evidence Rule

  In June 2007, CMS updated its Guidance (235Kb PDF file) that describes how the Best Available Evidence Rule works for people with Medicare and Medicaid (duals). The Best Available Evidence policy was reiterated by CMS in November 2007.

• Niacin

  Niacin is a vitamin and was therefore originally determined by the Centers for Medicare & Medicaid Services (CMS) to be excluded from Part D coverage. Niacin, however, in certain doses is an important therapeutic tool in the treatment of high cholesterol.

  CMS accordingly revised its policy (11Kb PDF file) to allow coverage of Niacin in therapeutic doses when prescribed for the reduction of high cholesterol.

• Vaccine Coverage - 2008

This CMS Provider Inquiry Assistance document, dated July 10, 2007, part of the CMS Medicare Learning Network for Medicare providers, describes Medicare Part D coverage for vaccines starting in 2008.