Medicare Part D – Prescription Drug
Prescription drug plans, also known as Part D, help to pay for covered drugs since Original Medicare does not cover them. To be eligible, you must be entitled to Part A and/or enrolled under 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 that will need to be met before benefits begin. After spending a government-set amount of money on medications, you will reach a coverage gap or even go past the coverage gap in a year. Copayments 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 appropriate use of these drugs. Your doctor can help you get approval.
The plan can ask you to start treatment with a cheap but effective drug (for instance, a generic name drug) instead of starting with a more expensive drug. 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 on 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 (Applies to Blue Cross MedicareRx Basic (PDP)SM)
- Tier 4 — Non-Preferred Brand Drugs (Applies to Blue Cross MedicareRx Value (PDP)SM and Blue Cross MedicareRx Plus (PDP)SM)
- Tier 5 — Specialty Drugs