What Does Part D Cover?
Medicare Part D covers prescription drugs. You can get Part D coverage by adding on a standalone Part D plan to your Original Medicare coverage, or you can find a Medicare Advantage plan that includes prescription coverage as an extra benefit.
Keep in mind that if you choose the Medicare Advantage route, you have to be enrolled in Original Medicare before joining a Medicare Advantage plan!
Each Part D plan has a list of prescription drugs that it covers. This list is known as a formulary. All Part D plans are required to cover two drugs from each class. They are also required to cover all drugs in six specific categories, which are:
✔ Immunosuppressants
✔ Antipsychotics
✔ Antidepressants
✔ Anticancer
✔ Anticonvulsants
✔ HIV/AIDS drugs
Part D will not cover:
𝙓 Cosmetic drugs
𝙓 Fertility or erectile dysfunction medications
𝙓 Weight loss or weight gain drugs
𝙓 Over-the-counter drugs
Part D Tiers
Part D plans will also generally divide the prescription drugs they cover into tiers to lower costs. The tiers will vary depending on the plan, but an example of what they may look like can look something like this:
- Tier 1 – Generic prescriptions with the lowest copayment
- Tier 2 – Preferred, brand-name prescriptions with a medium copayment
- Tier 3 – Non-preferred, brand-name prescriptions with a high copayment
Specialty Tier – High cost prescriptions with the highest copayment
Typically, a drug listed in a lower tier will be less expensive than a drug in a higher tier.
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