Medicare Part D

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 different costs. 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:

• Provide written notice to you at least 60 days prior to the date the change becomes effective.
• 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.

Costs for Medicare drug coverage

You’ll make these payments throughout the year in a Medicare drug plan:

• Premium
• Yearly deductible
• Copayments or coinsurance
• Costs in the coverage gap
• Costs if you get Extra Help*
• Costs if you pay a late enrollment penalty

Your actual drug plan costs will vary depending on:

• The drugs you use
• The plan you choose
• Whether you go to a pharmacy in your plan’s network
• Whether the drugs you use are on your plan’s formulary
• Whether you get Extra Help* paying your Medicare Part D costs

*Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles and coinsurance.