I’ve been in contact with a really great Medicare patient advocate for the state of Arizona, and he’s filled me in on why some drugs aren’t listed in the Medicare Drug Calculator :

In your tutorial , you mention that you have questions with the “Enter My
Medications” section. First, the Federal legislation expressively
prohibited Medicare Part D from providing barbiturates and benzodiazepines,
so they won’t show up. Second, an approved plan is only required to provide
two drugs in each treatment category, so many drugs are not on many of the
formularies, although they are also required to provide “substantially all”
drugs available for the treatment of Cancer, AIDS, and a list of other
conditions.

As all of us who’ve used the Plan Finder know, the prescription information
that the person provides us (even with their prescription bottles in front
of us or a pharmacy printout) doesn’t always match what’s available in the
Plan Finder’s prescription drug drop-down lists. A weird example is that I
have sometimes found a brand name only by going to the name of the generic,
and vice versa.

There is a significant challenge to us who don’t have a medical background.
I can sometimes narrow the specific form of a drug down by going to
http://www.rxlist.com/ and finding how the drug is provided, as I don’t have
a current PDF. As a fictional example: I find in the drop-down list that
there are both an “EX” form of a drug and a “TG” form. Looking at this
website (or PDR, or whatever), I see that the “EX” is available in 2.5, 5,
and 10 mg tablets, whereas the “TG” form is in a 10 ml vial, and the
prescription that the person is taking is 5 mg.

I always tell the person being screened when there is uncertainty as to one
of their prescriptions or when I have to leave a drug off the list. I
recommend that they contact the company(s) directly and find out how those
prescriptions will be handled, before enrolling.

Also, here’s a list he sent me of drug classes that have to covered under Medicare Part D:

REQUIRED COVERAGE FOR “ALL OR SUBSTANTIALLY ALL” MEDICATIONS FOR:

• Cancer medications
• HIV/AIDS treatments
• Antidepressants
• Antipsychotic medications
• Anticonvulsive treatments
• Immunosuppressants

(source: CMS webcast PowerPoint slide 4, 9/28/05)

MEDICATIONS EXCLUDED FROM COVERAGE UNDER MEDICARE PART D:
Drugs for:

• Anorexia, weight loss, or weight gain
• Fertility
• Cosmetic purposes or hair growth
• Symptomatic relief of cough and colds
• Prescription vitamins and mineral products
• Except prenatal vitamins and fluoride preparations
• Non-prescription drugs
• Barbiturates
• Benzodiazepines

(source: CMS 2005 REACH training, Module 10, May 29, 2005, PowerPoint, p.
59)

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