Chat with us, powered by LiveChat
(855) 740-2227

Medicare Part D Plan Formulary

If you rely on medications, it’s important to review each Part D plan’s formulary, to confirm the prescriptions you need are listed.

Formulary

Each plan has its list of covered prescription drugs, called a formulary. Medications are classified into tiers, the lowest costing less than those in higher tiers. Be sure to check that your medications are listed. If you don’t see yours listed, search for another plan. These lists often change yearly, meaning your medications may no longer be available next year. Prescription drugs change tiers or move between classifications. Even if you are happy with your coverage, you must review the Annual Notice of Change for the upcoming year to avoid being surprised at the pharmacy. 

Tier 1 – Generic, lowest copayment

Tier 2 – Preferred, brand-name, medium copayment

Tier 3 – Non-preferred brand name, higher copayment

Tier 4 – Specialty, highest copayment

Over-the-Counter

It’s important to know which medications will be covered under the plan, and which are not. Part D does not provide coverage for over-the-counter medications, including cough and cold medicine, and vitamins. Medicare covers some medications that Part D does not. For instance, vaccines, cancer drugs, and certain injectable drugs are covered under Part B if you receive them in an outpatient setting, like your doctor’s office.

Not Covered

In the event your medications are not covered under the plan, there are things you can do.

Substitutes

In many cases, formularies do not cover brand-name drugs but do offer coverage for generic, or low-cost alternatives. Ask your doctor if there is a substitute for the medication that’s not covered under your plan.

Exception

Medicare is open to listening to your doctor if he or she believes that a specific drug is the only medication that will help your condition. An exception may be granted if your doctor and Medicare agree that it is medically necessary. You also have the right to file an appeal should Medicare deny your request.

Change Coverage

Each plan is different, and your prescriptions may be covered under a different plan’s formulary. If your current coverage no longer covers your medication, and you find a new plan that does, you can change during Annual Enrollment  (October 15 –  December 7) each year.

 

 

Get a Part D Quote

 

 

 

 

 

 

 

 

References:

https://www.medicare.gov/part-d/coverage/part-d-coverage.html

https://www.medicare.gov/part-d/coverage/rules/drug-plan-coverage-rules.html

MUC67-2017-BCBS

Testimonial Suzon was very pleased with Lilly being professional, knowledgeable and great at what she does. S. Lanz, Woodridge
Testimonial Debbie was so polite. She didn’t make me feel incompetent when I didn’t understand something. S. Scheibly, Decatur
Testimonial Kathleen was helpful and provided me with information quickly! M. Greaney, Oak Lawn

Latest News

Read all the news

Avoid Medicare Part D Penalty

Whether or not you take prescription drugs, you may want to consider your options carefully when it comes to joining…
Read more

Medicare Part D Creditable Coverage

As a Medicare-eligible policyholder, you have the right to know whether or not your current drug coverage meets the standard…
Read more

Medicare Advantage Coverage and Enrollment Periods

Medicare Advantage is a cost-saving option for many seniors to cover out-of-pocket expenses associated with Medicare. These plans include many…
Read more

Medicare Supplement Plan G Coverage Details

Most seniors in Illinois choose Medicare Supplement Plan G, due to the low out-of-pocket costs, and coverage for foreign travel….
Read more

Medicare Part D Prescripton Plans

Medicare does not provide coverage for medications. There are two ways to receive prescription coverage, enroll in a Part D…
Read more