Medicare FAQs: Part D Coverage

Medicare FAQs: Part D Coverage

We’re going to be talking about Medicare Part D prescription drug coverage. This is for folks that are thinking about changing coverage. There are seven key questions that you should keep in mind when you’re thinking of or considering changing coverage.

1. How do you know your drugs are covered by a plan?

Well the main way to know if your drugs are covered by a plan is to look at the plan’s formulary. A formulary is just really fancy word for an approved drug list that each plan has. So you want to check with the formulary when you’re considering changing plans to make sure that your drugs are covered.

2. Are there lower cost generic medications available in place of brand names?

So that’s a question you’re going to have to ask the plan. If you’re taking brand name prescription drugs you’re going to want to know if the plan you’re considering offers lower cost generics. Finding this out will be to your benefit.

3. How large is the formulary?

The size of a formulary depends on the number of prescriptions in each plan’s formulary. You may have one insurance company that has several plans and each formulary could be different. So the way to figure this out is you just go to the company’s website, and find out which prescription drugs are on that list. Some plans have 2,500 prescriptions, and some plans offer 3,000 prescriptions, so the main thing is to make sure your drug, or your brand name your prescription, is in the formulary. It’s always in your best interest to find formularies with larger lists.

4. What can I do if the plan I’m looking at doesn’t cover my prescriptions?

If the plan you’re looking at doesn’t cover the drugs you’re taking, you might want to consider looking at another plan. A very important thing here though is, you can see if the plan you’re looking at might make an exception and can cover your particular prescription drug. Check to make sure they’re covered, check another plan, or ask for a drug exception.

5. What are price tiers and how did they apply to the medications I’m taking now?

This is another thing that you want to consider when choosing a prescription drug plan. Each prescription is categorized into a pricing tier. Generic prescriptions are tier one, tier two is preferred generics, and then you’ll see brand name prescriptions, preferred brand names, and specialty prescriptions. Each prescription you’re taking is categorized in one of those tiers. It’s important to know that insurance companies could put your one particular prescription in a lower priced tier, and another one could be in a higher priced tier. You’ll want to take note as to which price tier your prescriptions are in.

6. Are there any usage management restrictions?

The utilization of the management, what they’re really talking about is step therapy. Which is different ways that the insurance company can help control the cost. So basically what that means is that you might be required to start at a lower priced generic prescription. If that doesn’t work to you and your physician’s satisfaction, you can move into the next category, the more expensive prescriptions, until you find a drug that works. But that’s a way that the insurance companies can help you maintain the cost.

7. Do you have to have Medicare Parts A&B coverage to go with your Medicare Part D coverage?

No, you only need to be eligible or receiving Part B to be eligible for a Part D Prescription Drug Plan.

If you have any questions, please leave a comment below.

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