PRESCRIPTION DRUG PLAN
Original Medicare does not include Prescription Drug coverage. Once you start Medicare Part A and Part B you will need to enroll into a Prescription Drug plan whether it’s a stand-alone Prescription Drug Plan or a Medicare Advantage Plan with Prescription Drug coverage included. It is very important that you enroll into a Prescription Drug plan during your Initial enrollment period to avoid a penalty.
What you pay for Part D
Standalone Prescription Drug plans charge a monthly premium, and each plan sets the amount it charges. This monthly premium is in addition to your Medicare Part B premium which you continue to pay to Medicare.
Some Prescription Drug plans could also charge a deductible. Some plans may have a deductible just for certain formulary tiers and not for others or the deductible could vary from one drug tier to another.
A copay is generally required each time you fill a prescription for a covered drug. Copay amounts may vary depending on the tier level of the drug, with low-tier drugs costing less and also which pharmacy you use. Each plan sets its own copay terms and amounts.
Copays are more common, but some plans may set a coinsurance rate for certain drugs or drug tiers such as a percentage of the cost of a drug rather than a set copay amount.
The drugs that are covered on a Prescription Drug Plan can differ from plan to plan. Medicare sets standards for the types of drugs Part D plans must cover, but each plan chooses the specific brand name and generic drugs on its formulary. A Formulary is a list of covered drugs for the plan.
Many plans have a tiered formulary where covered drugs are divided into groups based on cost. In general, drugs on low tiers cost you less than drugs on high tiers.
Plans may also charge a deductible for certain drug tiers and not for others, or the deductible amount may differ based on the tier level.
Plans may require step therapy for certain drugs. This means you must first try a low-cost drug that has been shown to be effective in treating your condition before the plan will cover a more expensive drug. If the low-cost drug doesn’t work, you and your doctor can request approval from the plan to try the next-level treatment.
Things you should consider when choosing a Prescription Drug Plan.
- Are your medications on the plans formulary? Make sure the medications that you take are on the plan formulary. If your medications are not on the formulary check with your doctor to see if there’s a covered drug you can switch to if needed.
- Is there a generic option for your medication? If you are on a medication that is in a high tier, ask your doctor about a generic or lower-cost option.
- What is the plans preferred pharmacy? Save money on prescription medications by using the plans preferred pharmacy.
- Does the plan have a mail order pharmacy? You may save money by using the plans mail order pharmacy. You will get a 3-month supply of your medication delivered to your home.