Editing Medicare (United States) (section)

===Part D: Prescription drug plans===
{{Main|Medicare Part D|Medicare Part D coverage gap}}

[[Medicare Part D]] went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D, which covers mostly self-administered drugs.{{Citation needed|date=March 2025}} It was made possible by the passage of the [[Medicare Modernization Act]] of 2003. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or public Part C health plan with integrated prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by various sponsors including charities, integrated health delivery systems, unions and health insurance companies; almost all these sponsors in turn use pharmacy benefit managers in the same way as they are used by sponsors of health insurance for those not on Medicare. Unlike Original Medicare (Part A and B), Part D coverage is not standardized (though it is highly regulated by the Centers for Medicare and Medicaid Services). Plans choose which drugs they wish to cover (but must cover at least two drugs in 148 different categories and cover all or "substantially all" drugs in the following protected classes of drugs: anti-cancer; anti-psychotic; anti-convulsant, anti-depressants, immuno-suppressant, and HIV and AIDS drugs). The plans can also specify, with CMS approval, at what level (or tier) they wish to cover it, and are encouraged to use [[step therapy]]. Some drugs are excluded from coverage altogether and Part D plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.<ref>{{cite web |url=http://oig.hhs.gov/oas/reports/region6/60600022.pdf |title=Report on the Medicare Drug Discount Card Program Sponsor McKesson Health Solutions, A-06-06-00022 |access-date=February 19, 2011 |archive-url=https://web.archive.org/web/20110717232756/http://oig.hhs.gov/oas/reports/region6/60600022.pdf |archive-date=July 17, 2011 |url-status=dead }}</ref>