What drugs are covered under Medicare Part D?
How do I find out if my medications are covered under Medicare Part D?
To find out if your medications are covered under Medicare Part D, you’ll need to review your plan’s formulary (the list of covered drugs). Each Medicare Part D plan has its own formulary, and medications are categorized into tiers that determine your costs. Here’s how you can check if your prescriptions are covered:
1. Review the Plan’s Formulary:
What is a Formulary?: A formulary is a list of prescription drugs covered by a Medicare Part D plan. These drugs are categorized into tiers, with lower-cost generic drugs typically in Tier 1 and more expensive brand-name or specialty drugs in higher tiers. Each tier comes with different copayment or coinsurance amounts.
How to Find the Formulary: You can access the formulary by visiting your plan’s website or by requesting a printed copy from your plan’s customer service. You can also view formularies online by using Medicare’s Plan Finder Tool at Medicare.gov.
2. Use the Medicare Plan Finder Tool:
Medicare Plan Finder: The Medicare Plan Finder Tool on the official Medicare website allows you to compare Medicare Part D plans based on your medications. You can enter your prescription drug names, dosages, and preferred pharmacies to find plans that cover your medications.
Step-by-Step Guide:
Go to Medicare Plan Finder.
Enter your zip code and basic information.
Enter your medications and dosages.
The tool will show you which Part D plans cover your drugs and the associated costs.
3. Check Coverage Tiers and Restrictions:
Tiers: Medications on a Part D formulary are grouped into tiers. Lower tiers generally have lower out-of-pocket costs, while higher-tier drugs (such as brand-name or specialty drugs) may cost more. If your drug is on a higher tier, you may want to ask your doctor about switching to a lower-tier alternative.
Restrictions: Some Part D plans may have restrictions on certain medications, such as:
Prior Authorization: You or your doctor must get approval from the plan before the medication will be covered.
Step Therapy: You may need to try a lower-cost drug before the plan covers a higher-cost drug.
Quantity Limits: The plan may limit the number of doses or pills you can get in a certain time period.
4. Ask Your Plan Directly:
If you’re already enrolled in a Medicare Part D plan, you can contact your plan’s customer service to confirm whether your medications are covered and what the associated costs will be. The phone number can be found on your Part D plan membership card.
5. Get Personalized Help:
For assistance finding a Medicare Part D plan that covers your specific medications or if you have any questions about the costs, you can schedule an appointment with a Tsunami Advisor who can guide you through the process: Schedule an Appointment.
Key Takeaways:
Use your plan’s formulary or the Medicare Plan Finder Tool to check if your medications are covered.
Check the tier of your medications to understand your out-of-pocket costs.
Some medications may have coverage restrictions, so review your plan’s policies carefully.
