MEDICARE RX BYTES

Niacin Will Be Removed From Part D Coverage

As a general rule, prescription vitamins and mineral products (except prenatal vitamins and fluoride preparations) are excluded from Part D coverage by statute. At the start of Medicare Part D, it was unclear whether prescription niacin products (e.g., Niaspan, Niacor) should be considered a prescription vitamin and therefore excluded from Part D coverage. As a result, some plans covered prescription niacin products and some plans did not. 

The Centers for Medicare & Medicare Services (CMS) has now announced that prescription niacin products are prescription vitamins and therefore excluded from Part D coverage. After May 31, 2006, Niaspan and Niacor must not reside on Part D plan's formularies and not available to Medicare beneficiaries under Part D coverage. Pharmacists should not bill for Niaspan or Niacor to Part D after May 31 and should exercise caution billing for prescription niacin products in the meantime. 

As a reminder, there are several classes of prescription drugs that are excluded from Medicare Part D by statute.  They include:

• Drugs when used for anorexia, weight loss, or weight gain
• Drugs when used to promote fertility
• Drugs when used for cosmetic purposes or hair growth
• Drugs when used for the symptomatic relief of cough and colds
• Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
• Nonprescription drugs
• Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale
• Barbiturates
• Benzodiazepines
• Any drugs available under Parts A or B of Medicare