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Medicare Part D
Prescription Drug Coverage 2027
What Does Medicare Part D Cover in 2027? Covered and Excluded Drugs
Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated November 2, 2026
Medicare Part D covers most outpatient prescription drugs you fill at a pharmacy in 2027, along with covered insulin at no more than $35 a month and CDC-recommended adult vaccines at $0. Federal law leaves out a short list of drug types, such as weight-loss-only, fertility and cosmetic drugs, and some medicines given in a doctor’s office are paid by Part B instead.
2027 by the Numbers
$35
monthly limit for a covered insulin in 2027 (CMS)
$0
cost of ACIP-recommended adult vaccines under Part D (CMS)
8
drug categories Medicare excludes from Part D by law (Medicare Rights Center)
Coverage under Part D works in two layers. Federal law draws the outer boundary: what kinds of drugs a Part D plan is allowed to pay for at all. Inside that boundary, each private plan builds its own drug list, so a medicine that qualifies under the law may still be missing from a particular plan. Knowing which layer a coverage question belongs to saves a lot of guesswork.
This page focuses on the outer boundary for 2027: the drug types Part D includes, the ones the law shuts out, and the drugs that belong to Part B. Plan drug lists and tiers have their own guide, the Medicare Part D formulary 2027, and costs are summarized on the Medicare Part D plans 2027 hub.
Key Takeaways
- Part D pays for FDA-approved outpatient prescriptions used for a medically accepted purpose, when they are on the plan’s drug list.
- Plans must cover all or nearly all drugs in six protected classes, including antidepressants and cancer drugs.
- The law excludes weight-loss-only, fertility, cosmetic, hair-growth, erectile dysfunction, cough-and-cold, most vitamin and over-the-counter drugs.
- Drugs given by injection or infusion in a doctor’s office usually fall under Part B, not Part D.
- Weight-loss use of Wegovy and Zepbound runs through a separate GLP-1 Bridge whose $50 copay does not count toward the $2,400 limit.
The Basic Test a Drug Must Pass
For a drug to be paid under Part D, it generally has to meet several conditions at once. It needs a prescription, FDA approval, and a use that is FDA-approved or supported by the medical references Medicare recognizes. It also has to be on the drug list of the plan you joined, or be approved through an exception.
Six protected classes plans must cover broadly
✔
Antidepressants
✔
Antipsychotics
✔
Anticonvulsants used for seizures
✔
Immunosuppressants used after organ transplants
✔
Antiretrovirals used to treat HIV
✔
Antineoplastics used to treat cancer
For these six groups, CMS requires plans to include all or substantially all drugs, though plans can still use prior authorization in some cases. Outside them, plans need at least two drugs in each category and class, which is why one plan may carry your brand and another may not.
Drug Types the Law Keeps Out of Part D
| Excluded category | Common exception |
|---|---|
| Weight loss, weight gain or appetite | Treatment of wasting from AIDS, cancer or other illness may be covered |
| Fertility drugs | None in the standard benefit |
| Cosmetic use or hair growth | Drugs for acne, psoriasis, rosacea or vitiligo are not treated as cosmetic |
| Relief of cough or cold symptoms only | May be covered when prescribed for a different approved condition |
| Erectile dysfunction | May be covered for another FDA-approved use |
| Prescription vitamins and minerals | Prenatal vitamins and fluoride preparations are covered |
| Over-the-counter drugs | Some plans add limited extras as a supplemental benefit |
| Drugs rated less than effective by FDA review (DESI) | None |
Source: Social Security Act exclusions as summarized by the Medicare Rights Center. An enhanced plan may add some excluded drugs as an extra, depending on the plan.
Cost trap: money spent on an excluded drug does not count toward the $700 deductible or the $2,400 yearly limit, even when a plan offers it as an extra.
Part B or Part D: Which One Pays
The same medicine can be billed to different parts of Medicare depending on how and where you get it. A rough rule: if a clinician gives it to you, Part B usually pays; if you pick it up at a pharmacy and take it at home, Part D usually pays.
Usually Part B
✔
Infusions and injections given in a doctor’s office or hospital outpatient clinic
✔
Some oral cancer and anti-nausea drugs tied to chemotherapy
✔
Transplant drugs when Medicare paid for the transplant
✔
Insulin used with a covered insulin pump
✔
Flu, pneumonia and COVID-19 shots
Usually Part D
✔
Pills, inhalers and self-injected drugs filled at a pharmacy
✔
Shingles, RSV and Tdap vaccines
✔
Most insulin used with pens or syringes
✔
Transplant drugs when Medicare did not pay for the transplant
Part B drugs carry Part B’s own cost sharing, usually 20% after the Part B deductible for people without supplemental coverage. Vaccine details are on our Medicare Part D vaccines 2027 page.
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Insulin, Vaccines and Negotiated Drugs in 2027
$35
most you pay for a month of each covered insulin, deductible skipped
$0
ACIP-recommended adult vaccines, including shingles
25
drugs with Medicare negotiated prices once the 15 new ones start January 1, 2027
The negotiated price program does not add drugs to Part D; it lowers the price of drugs that were already coverable. Ozempic, Trelegy Ellipta, Xtandi and twelve others join the first ten, such as Eliquis and Jardiance. A lower price can shrink your 25% share, but plans still decide which negotiated drugs appear on their lists and on which tier.
Weight-Loss Drugs and the Separate GLP-1 Bridge
Weight-loss-only drugs remain excluded from the Part D benefit in 2027. Since July 1, 2026, Medicare has run a separate GLP-1 Bridge for weight management, and CMS has extended it through December 31, 2027. Eligible drugs include Wegovy, Foundayo and the Zepbound KwikPen, for a $50 copay per fill.
Detail most guides miss: CMS guidance states that no part of the $50 Bridge copay counts toward true out-of-pocket costs, so it never moves a person closer to the $2,400 limit, and Extra Help does not reduce it.
When the same drug is prescribed for a use Part D does cover, such as lowering heart attack and stroke risk, it is billed to your plan instead. Our Wegovy coverage 2027 page walks through that split.
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Our Math: Covered vs Excluded Over a Year
Whether a drug is covered changes more than its price at the counter. It decides whether the spending protects you later in the year. The comparison below uses the 2027 standard design.
| Drug situation | Monthly cost to you | Cost for 2027 | Counts toward $2,400? |
|---|---|---|---|
| Covered insulin | Up to $35 | Up to $420 | Yes |
| Covered brand drug, $300 full price | $300, then $75 after deductible | $1,425 | Yes |
| Excluded drug, $100 full price | $100 | $1,200 | No |
| GLP-1 Bridge weight-loss fill | $50 | $600 | No |
Our calculation from CMS 2027 parameters, assuming the full $700 deductible and 25% coinsurance; premiums not included. Plan copays may differ.
The covered brand drug costs more in the first months, yet every dollar of it builds toward the cap. The excluded drug and the Bridge fills never do, no matter how long they run.
Confirming Coverage Before December 7
1
Sort your list by type. Mark which drugs come from a pharmacy and which are given in a clinic; the clinic drugs may be Part B.
2
Look for excluded categories. Vitamins, cough-and-cold products and weight-loss-only drugs will not be paid by the standard benefit.
3
Check each plan’s 2027 drug list. Not all plans cover every drug, and tiers and limits differ by plan and area.
4
Ask about exceptions. A prescriber can request a formulary exception if a needed drug is missing.
Premium figures for the plans you shortlist are explained on our Medicare Part D premium 2027 page. Changes chosen during open enrollment start January 1, 2027.
The Bottom Line
The Bottom Line
Part D covers most pharmacy-filled prescriptions in 2027, plus capped insulin and $0 recommended vaccines, while the law keeps out a fixed list of drug types. Separate what Part B pays and what the law excludes before you compare plan drug lists.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options.
Frequently Asked Questions
➤ What drugs does Medicare Part D cover in 2027?
Most FDA-approved outpatient prescription drugs used for an accepted medical purpose, when they are on your plan’s drug list. Coverage of any one drug depends on the plan.
➤ What drugs are never covered by Part D?
The law excludes drugs used only for weight loss or gain, fertility, cosmetic use or hair growth, erectile dysfunction and cough or cold relief, plus most prescription vitamins and over-the-counter products.
➤ Does Part D cover insulin in 2027?
Yes. Covered insulin costs no more than $35 for a month’s supply, and the deductible does not apply. Insulin used with a pump is usually covered under Part B instead.
➤ Are shots covered by Part D?
Adult vaccines recommended by the CDC’s advisory committee, like shingles and RSV, cost $0 under Part D. Flu, pneumonia and COVID-19 shots are covered by Part B.
➤ Does Part D pay for drugs given in a doctor’s office?
Usually not. Injections and infusions given by a clinician are generally Part B drugs. A few self-injected drugs are Part D even if you learn to use them in the office.
➤ Does Part D cover Wegovy or Zepbound for weight loss?
Not under the standard benefit. Weight-loss use goes through Medicare’s GLP-1 Bridge through December 31, 2027, with a $50 copay that does not count toward the $2,400 limit.
➤ Does Part D cover vitamins?
Generally no. Prenatal vitamins and fluoride preparations are the main exceptions allowed under Part D rules.
➤ Why is my drug covered by one plan but not another?
Federal rules set what Part D may cover, but each plan chooses its own drug list within those rules. Only the six protected classes must be covered broadly by all Part D plans.
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