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Which Prescription Drugs are Covered under the Medicare Part D plans?
The list of prescription drugs covered by the Medicare Part D plans (or a Plan's Formulary) can vary plan to plan. However, every therapeutic category of prescription drugs will be covered under the Medicare Part D prescription drug plans.
Medicare Part D plans must cover all or substantially all drugs in six categories: antidepressants,
antipsychotics, anticonvulsants, antiretrovirals (AIDS treatment), immunosuppressants
and anticancer.
Naturally, not every plan will cover each drug and Medicare beneficiaries must therefore choose a plan that best accommodates all of their personal prescription drug needs and financial situation.
More specifically, some plans will provide coverage for generic drugs, while other plans will focus on providing a wide range of name-brand prescription drugs. As noted, plan premiums will reflect the plan's coverage.
To quickly compare where your medication falls on every plan in your state, use either our Part D Drug Finder (Formulary Search) or Browse Drugs By Letter . You will not only see the cost-sharing (co-payment/co-insurance) for this medication on each Medicare Part D plan, but also the utilization management requirements, including step therapy, prior authorization and the exact quantity limits. For example, Q:15/30Days -- quantity limit of 15 pills per 30 day period.
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Please note: All Medicare Part D plans must have a process in place for members to request exceptions to the plan's
formulary if a non-covered drug is deemed medically necessary and or if they require an exception to the utilization management requirements, including quantity limits.
Many plans are using a "tiered" approach to their Prescription Drug List (also known as a Formulary). Specific drugs are in each Tier and will have a co-payment that increases with the level of Tier. Therefore, the co-pay for Tier 3 Drugs is higher than the co-pay for Tier 1 Drugs. Also, some plans reduce the amount of co-pay per Tier depending on if you purchase their Low, Middle, or Higher Premium Plan.
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For Example:
| Plan |
Lower Premium Plan |
Middle Premium Plan |
Higher Premium Plan |
Co-payment
Tier 1/2/3 |
$12 / $36 |
$5 / $20 / $53 |
$0 / $20 / $55 |
| Premium per Month |
$20.07 |
$30.46 |
$44.47 |
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Last updated on: 09/22/2011
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