Let’s talk: Prescription Drugs (Part D)
Medicare Part D is the federal government’s optional prescription drug program that covers both brand-name and generic prescription drugs.
Find out more below.
Prescription Drug Plans cover:
List of Covered Drugs
Also known as a Formulary.
The formulary is a list of the covered generic and brand name drugs each plan will cover. Medicare requires that each plan must cover at least two drugs in each most commonly prescribed category or class.
Plans have the opportunity to select the drugs that make up their formulary. This means that although each plan has drugs in each category not every plan will cover your specific drugs for your medical condition, but they will cover similar drugs.
Formulary exists in Tiers
Many formularies have at least 4 tiers which they breakdown their list of covered drugs in order to lower drug costs.
Tier 1 – lowest drug copayment – most generic drugs
Tier 2 – medium drug copayment – preferred brand name drugs
Tier 3 – higher drug copayment – non-preferred brand name drugs
Tier 4 – highest drug copayment – specialty drugs
Drug Plan Coverage Rules
Prior Authorization
Each plan has an option which allows you to cover specific drugs when they are medically necessary even if not covered by the plans formulary.
Quantity limits
In order to save money and ensure safety, the plans may implement quantity limits. If your doctor believes that the quantity limits are not sufficient for your medical needs you can request an exception to these quantity limits.
Step Therapy
When the drug you are taking is on a high tier level, your plan may require that you attempt to take lower tier drugs first to ensure both you and the plan save money. If your doctor believes that the quantity limits are not sufficient for your medical needs you can request an exception.
Let's get together!
We would love to meet you
We can help you find a plan that will work best for your situation.