Medicare Part D Prescription Drug Coverage

What prescription drugs are covered under Medicare Part D?

Medicare Part D Prescription Drug Plans create a list of prescription drugs that they will cover, called a formulary. These update every year, and the plans notify all beneficiaries with an Annual Notice of Change. Some changes may be due to new generic brands becoming available or prices changing.

What is Covered?

Each company that provides Part D coverage is committed to covering at least two prescription drugs for each of the most commonly prescribed categories. One of these is often a generic option.

Part D plans are required to cover virtually all drugs in six categories: antidepressants, antipsychotics, anticonvulsants, antiretrovirals (AIDS treatment), immunosuppressants, and anticancer. 

Within a formulary, drugs are grouped into tiers that determine the copayment you are responsible for. Generic options are the cheapest, followed by brand name, then specialty prescriptions, and non-preferred choices.

If you need a prescription that is not covered by your plan’s formulary, you and your prescriber can request an exception. For medically necessary treatment or needed adjustments in quantity, the authority of your prescriber should allow these changes to come to fruition.

For any changes made to a drug you are currently taking, your plan will ensure that you are covered for 30 days. You will be notified of changes when you fill your prescription and are given a supply of 30 days, or you will be notified 30 days in advance of the change.

General Enrollment Period

Each plan has different coverage and varying costs. Because they provide the Annual Notice of Change in the fall, it is recommended that you review your policy to make sure your prescriptions will still be covered. If you need to make changes, you can do so during the General Enrollment Period from October 15 to December 7.

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