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No, Medicare doesn’t automatically cover prescription drugs you get at a pharmacy, but you can buy a Medicare Part D plan from a private insurer to help cover those expenses. You can either get a stand-alone Part D plan or purchase a Medicare Advantage plan that provides medical and drug coverage in its benefits package.
Medicare introduced these prescription drug coverage benefits in 2006. In 2022, 75 percent of all Medicare beneficiaries — nearly 49 million people — were enrolled in Part D plans. More than half (53 percent) were in Medicare Advantage plans with drug coverage while 47 percent were enrolled in stand-alone Part D plans, according to the Kaiser Family Foundation. This was the first year that more people had drug coverage through Medicare Advantage plans than from stand-alone Part D plans.
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Specific coverage varies by plan and, typically, you have many to choose from depending on your location. In 2023, the average Medicare beneficiary had a choice of 24 stand-alone Part D plans and 35 Medicare Advantage plans. Find out about the plans available in your area by typing your zip code into Medicare’s Plan Finder.
Other parts of Medicare generally cover drugs that medical professionals provide at a doctor’s office, hospital or specialty clinic. For example, Medicare Part B covers chemotherapy, dialysis and other medications injected or given intravenously at a doctor’s office or outpatient center.
What drugs must Part D cover?
Each Medicare Part D plan has a formulary, a list of covered medications, that includes both generic and brand-name prescriptions. You generally will have higher out-of-pocket costs for brand-name drugs.
Formularies vary from plan to plan, but federal law requires that all Medicare Part D plans include at least two drugs in the most commonly prescribed categories and all medications in the following categories:
- Anticancer drugs except where covered by Part B
- Anticonvulsant treatments for seizure disorders
- Antidepressants
- Antipsychotic medications
- HIV/AIDs drugs
- Immunosuppressant drugs
Part D plans must include coverage for most commercially available vaccines, including inoculations to prevent shingles. Part B, though, covers flu, hepatitis B and pneumonia vaccinations. The government also will pay for your COVID-19 vaccinations if you're covered under any of the four parts of Medicare.
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