Rx Drug Coverage | Medicare Part D (PDP) Prescription Drug Plans help with prescriptions.
Each Medicare Prescription Drug Plan has its own Formulary – a list of covered drugs. The formulary can change each year, which is one of the many reasons Medicare allows you to explore and choose the plan that covers your particular medications during your Medicare Annual Enrollment Period. Medicare Prescription Drug Plans place drugs into tiers on their formularies, each with a different cost. A drug in a lower tier will usually cost less than a drug in a higher tier. The plan you choose; the drugs you use (i.e., generic or name brand); whether you use a network pharmacy; if your drugs are on your plan’s formulary; & if you get Extra Help from Medicare will all affect your total out-of-pocket drug costs.
Drug Plans may have coverage rules to reduce costs.
If a medication you are taking is restricted by these coverage rules, you can ask your Part D Plan for an exception. These rules include Prior Authorization, where you and the prescribing physician need to contact the plan before you can receive certain medications at the pharmacy. Often the prescriber will need to show that the drug is medically necessary. Quantity Limits are another type of coverage rule that puts limitations on how much medication you can obtain at the pharmacy at one time. Step Therapy may also be a coverage rule for your medications under your plan. Step Therapy requires you to first try one or more similar medications before the plan will cover your prescribed medication.
We are here to support your decisions.
Medicare Advantage plans may include Prescription Drug Coverage benefits. There are many Medicare insurance options available. Individual review of your Medicare insurance needs with a certified Professional Agent will give you confidence to choose the right Medicare Part D Prescription Drug Plan.