Limits on Our Medicare Prescription Coverages
For certain prescription drugs, MVP has additional requirements for coverage or limits on our coverage. These requirements and limits help us control drug plan costs and ensure that our members use these drugs in the most effective way. A team of doctors and pharmacists developed these requirements and limits for our health plans to help us provide quality coverage to our members.
Why Are Certain Drugs Not Covered?
Medicare rules do not allow Medicare Advantage plans to cover certain drugs, including:
- Drugs purchased outside of the United States
- Drugs used “off-label” (to treat conditions other than those the Food and Drug Administration has approved them to treat)
- Drugs used to treat erectile dysfunction or for cosmetic purposes
- Medications for cough or cold
- Vitamins and mineral products
For safety reasons and/or cost savings, certain drugs have limits on the amount that we will cover.
View the full list of medications with quantity limits for 2023 (PDF).
View the full list of medications with quantity limits for 2022 (PDF).
For safety reasons and/or cost savings, certain drugs need approval from us before you can fill them.
View the full list of medications that need prior authorizations for 2023 (PDF) .
View the full list of medications that need prior authorizations for 2022 (PDF).
Coverage determinations let you ask us for exceptions to our policies about prescription drugs. Learn more about coverage determinations.
Reach out to our Medicare Customer Care Center with questions or to enroll in a Medicare Advantage plan. Call seven days a week, 8 am–8 pm, Eastern time. From April 1–September 30, call Monday-–Friday, 8 am–8 pm.