If you are covered by a Medicare Part D prescription drug plan – or you are considering the purchase of such a plan – it is important to have a good understanding of what exactly is and is not covered.
Unlike Medicare Part A and Part B (also known as Original Medicare), the many Medicare Part D drug plans that are available in the market today are not offered directly by Medicare itself, but rather through private insurance carriers.
Because of that, Medicare Part D plans can vary – sometimes significantly – from one to another with regard to the premium that is charged, as well as regarding the medications that may be covered (and in turn, the extent of that coverage).
A Medicare Part D formulary is a list of prescription medications that is used by practitioners in identifying drugs that may offer the greatest overall value. These medications can include both brand name and generic options.
Formularies are required to include a wide range of different medications in the most commonly prescribed classes and categories. This can help to better ensure that enrollees who have different medical needs can obtain the medication that they require.
Medicare Part D drug formularies are organized according to the following categories:
In the section on what is covered, the name of the medications will be listed on the left hand side, and they are grouped alphabetically by their therapeutic category. To the right of the What is Covered section is the category of How It Is Covered. Here you will find the tier number that is assigned to each of the medications. To the right of that, you will find details on any restrictions that may apply to each particular drug.
In the Restrictions area, there are a number of different abbreviations that you may find. These can include the following:
While the Medicare Part D formulary may at first seem to be somewhat intimidating, knowing what to look for can be extremely helpful in pointing you in the right direction with regard to which drug plan may be best for you and your specific needs.