Every Medicare Part D plan will have a formulary, also known as a list that describes the prescriptions the plan will cover. Medicare requires that Part D plans have to cover two drugs from each class. Part D plans must also cover all, if not most, of the prescription drugs in these specific classes:
- HIV/AIDS drugs
Part D plans will also cover vaccines that are used to prevent disease or illness.
A Medicare Part D plan will not cover:
- Fertility drugs or drugs for erectile dysfunction
- Drugs for hair growth
- Drugs for weight loss or weight gain
- Drugs for cosmetic purposes
- Over-the-counter drugs
The monthly premium for Part D will vary among plans and your income, but the standard premium in 2021 is $30.50. However, you can have a Part D plan with a premium as low as $7 or up to $100 or more.
Some Part D plans will have a deductible of $445, but as of 2021, the deductibles cannot be higher than that amount. Other Part D plans will waive the deductible entirely.
Part D plans will also typically add the prescriptions they cover into a tier-system. The prescriptions in each tier will have a different cost, but those in a lower tier will cost less than those in a higher tier. An example of a tier-system would look something like this:
- Tier 1—Has the lowest copayment with the most generic prescriptions.
- Tier 2—Has a medium copayment with preferred and brand name prescriptions.
- Tier 3—Has a higher copayment with non-preferred and brand name prescriptions.
- Specialty Tier—Has the highest copayment with very high costing prescriptions.
What rights do you have?
Once you have a prescription drug plan, you will have several rights that include:
- Get an explanation from your drug plan about your benefits.
- Ask for an exception if you need a prescription that is not covered by your plan.
- Ask for an exception to waive a coverage rule.
- Ask to get a lower copayment for a high-costing prescription that your prescriber deems is necessary and cannot be substituted for a cheaper alternative.
If you are in need of prescription drug coverage, reach out to Caring Insurance Solutions today! We can help you compare all your plan options in the states of Oklahoma and Texas. Give us a call today at 405-694-0892.
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