What Are the Six Protected Classes of Drugs Covered By Medicare?

Christian Worstell
In this article...
  • Every Medicare Part D plan is required to cover certain protected classes of drugs. Learn more about which prescriptions are protected under this requirement.

There are six protected classes of drugs covered by Medicare Part D prescription drug plans. Regardless of which Medicare Part D provider you have, every plan is required by the Department of Health and Human Services to cover these six protected classes.

This federal rule helps ensure quality of care to all older adults who are enrolled in Medicare. 

What Are the Six Protected Classes of Drugs?

The six protected classes of drugs include the following:

  • Anticonvulsants: Primarily used to treat epileptic seizures but sometimes used to treat bipolar disorder and borderline personality disorders
  • Antidepressants: Treat depression, anxiety disorders and certain chronic pain conditions and can be used to manage substance abuse issues
  • Antineoplastics: Treat cancer, arthritis and multiple sclerosis, among other conditions
  • Antipsychotics: Often used to treat bipolar disorder but can be prescribed for other mental illnesses
  • Antiretrovirals: Used to treat HIV and hepatitis 
  • Immunosuppressants: Prescribed to treat many conditions, including Crohn’s disease, rheumatoid arthritis and multiple sclerosis, and used in nearly all organ transplant cases

Which Drugs in the Six Protected Classes Are Covered? 

While every Medicare Plan D provider is required to cover drugs in the six protected classes, the exact drugs that each provider covers varies. The list of drugs that each Medicare Plan D provider covers is called a formulary, and every insurer's formulary is different.

The one thing that every Medicare Plan D plan has in common is that, by law, its formulary must cover two drugs in each of the six protected classes. Each formulary also covers both generic and name brand drugs.

While Medicare Plan D providers can change the list of drugs they offer in the six protected classes at any time, they must notify enrollees when they do so. 

Didn't the Federal Government Change the Rule on Protected Classes of Drugs in 2021?

You may have concerns over having seen or heard news about the federal government giving Medicare Part D providers the option to drop coverage of certain protected classes of drugs.

The rule change was announced on January 19, 2021, and would allow Medicare Part D providers to stop covering certain drugs in five of the six classes protected starting in 2022. However, this proposed rule was struck down before it took effect, ensuring  that every Medicare Part D provider is still required to cover the whole range of drugs in the six protected classes of drugs.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with HelpAdivsor.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@MyHelpAdvisor.com.

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