The Centers for Medicare & Medicaid Services (CMS) excludes certain drugs from Medicare Part D coverage. However, we have noticed that providers continually prescribe these medications. Appeal requests for excluded drugs will be denied, consistent with CMS rules. To give your patient the best experience, you should not prescribe Part D-excluded drugs.

We have created a flyer that contains examples of drugs that are excluded from coverage, as well as a QR Code that opens Chapter 6 of CMS’s Medicare Prescription Drug Benefit Manual. This chapter contains more detailed information on these exclusions.

We recommend you review this list before prescribing drugs in the excluded drug categories. Providers with questions can contact Customer Service at 1-800-ASK-BLUE. ​