Prescription Drug Plans (Part D)

Eligible parties across the U.S. have the option of enrolling in a Medicare (Part D) plan to receive their prescription drug coverage. Medicare (Part D) plans are offered through private insurance companies that are contracted by Medicare, so costs and availability may differ between carriers and by location.

Part D plans include stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MAPD) plans. Medicare requires that all beneficiaries have some sort of creditable drug coverage, which includes Medicare (Part D) plans and employer health coverage. It is recommended that beneficiaries enroll in a Medicare (Part D) plan when they are first eligible to avoid any late enrollment penalties.

Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.

A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.

A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
(1) Provide written notice to you at least 60 days prior to the date the change becomes effective.
(2) At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change.