Medicare Part D – Prescription Drug
Prescription drug plans, also known as Part D, help to pay for prescription drugs since Original Medicare does not cover them. To be eligible, you must be entitled to Part A and/or enrolled in Part B. If you don’t enroll in Part D when you are first eligible, you may have to pay a penalty later.
You will pay a copay or coinsurance for your prescriptions. Some plans also have a deductible, which is a set amount you are required to pay out of pocket before the plan begins to pay for covered costs. After spending a government-set amount of money on medications, you will reach a coverage gap or may even go beyond the coverage gap in a year. Copays and coinsurances can change during these times.
Some drugs need to be approved by the plan before they are covered. This is so the plan can best guide the appropriate use of these drugs. Your doctor can help you get approval.
The plan can prefer you to start treatment with a less expensive but effective drug (for instance, a generic name drug) instead of starting with a more expensive one. If the first drug does not work for you, then the plan will cover the more expensive drug.
There can be limits on how much of a drug you’re allowed. The limit could be for how many pills you get with each prescription or how many times the prescription can be refilled. Generally, these limits are based on safety guidelines.
Drugs Are Placed into Tiers
In prescription drug plans, drugs are placed into tiers. The costs for drugs in each tier are different. Generally, drugs in lower-number tiers cost less. The tiers are:
- Tier 1 — Preferred Generic Drugs
- Tier 2 — Generic Drugs
- Tier 3 — Preferred Brand Drugs
- Tier 4 — Non-Preferred Drugs
- Tier 5 — Specialty Drugs