Medicare Part D offers prescription drug coverage and can usually be purchased as a standalone plan with Original Medicare or as an added benefit with a Medicare Advantage Plan. In Medicare Part D, the formulary list contains a list of drugs that are covered in the plan. This list can change at any time, though the Medicare Part D provider will typically inform the beneficiary if that happens. 

Coverage

As mentioned above, each Part D plan has a formulary that lists the covered prescriptions in the plan. Every Part D plan must provide coverage for at least two drugs in each class, as well as cover all drugs in these specific classes:

• Immunosuppressants
• HIV/AIDS drugs
• Anticancer
• Antidepressants
• Antipsychotics
• Anticonvulsants
• Common vaccines that can prevent an illness

Part D plans will also typically choose what will not be covered. While this can vary among plans, most Part D plans will not provide coverage for:

• Weight loss drugs
• Weight gain drugs
• Cosmetic drugs
• Hair growth drugs
• Fertility drugs
• Erectile dysfunction medications
• Over-the-counter drugs

Part D Tiers

Part D plans will typically list the prescriptions they cover into what are known as tiers. These tiers are used to lower the costs of the prescriptions, and while each plan will divide its tiers in different ways, a prescription listed in the lowest tier will generally cost less than those listed in a higher tier.

Keep in mind that each tier may be different, but an example of a Medicare Part D plan’s tier could look like this:

• Tier 1 – Usually consists of the lowest copayment with the most generic prescriptions.
• Tier 2 – Medium copayment with preferred, brand-name prescriptions.
• Tier 3 – Higher copayment with non-preferred, brand name prescriptions.
• Specialty Tier – Typically has the highest copayment, with high-costing prescriptions.

Suppose you have a prescription that is in a higher tier, and your doctor thinks you need this particular prescription rather than a similar one from a lower tier. In that case, you or your provider can ask your Part D plan for an exception to get a lower copayment.
There are many Part D plans to choose from. Get help sifting through them. Contact the Medicare experts at Game Changing Benefits to find a Part D policy that’s right for you. Call us today at 972-331-1060​!