Medicare Part D

From Pharmacy Drug Guide

Medicare is a program offered by the U.S. Federal Government that provides health insurance for people 65 years or older, under age 65 with certain disabilities, and any age with end-stage renal disease (ESRD) or Lou Gehrig's disease.^[1] The Medicare program consists of four parts: Part A - Hospital Insurance, Part B - Medical Insurance, Part C - Medicare Advantage Plans, and Part D - Prescription Drug Coverage.^[1]

Medicare Part D is an optional plan that helps Medicare recipients with their prescription drug costs. In order to receive Medicare prescription drug coverage, patients must be enrolled in a Medicare drug plan with an insurance company or other private company approved by Medicare. Depending on where you live, there might be multiple Medicare drug plans from which to choose. To find a plan in your area, call 1-800-MEDICARE or go to the Find-A-Plan page on the Medicare website.^[2]

Contents 1 Medicare Part D Overview 2 Medicare Plan Finder 3 Medicare Part D Donut Hole 4 Patient Assistance Program Overview 5 References

Medicare Part D Overview

Medicare Part D can help consumers cover the cost of prescription drugs, and may help lower prescription drug costs and protect against increased costs in the future. There are specific requirements as to when consumers can join a Medicare drug plan. In addition to the annual open enrollment period, which runs from October 15 – December 7, consumers can enroll in a Medicare drug plan upon becoming eligible for Medicare due to age or disability. Consumers who qualify for Extra Help can enroll at any time.^[3]

Consumers should be aware of the late enrollment penalty that can be added to their Part D monthly premium. This penalty can be assessed if consumers choose not to enroll when they first became eligible and do not have other creditable prescription drug coverage for more than 63 days in a row, at any time, after their eligibility ends.^[3]

It is important to choose a Medicare drug plan carefully as they can differ in the drugs they cover and the rules for obtaining coverage. Medicare drug plans must cover all commercially-available vaccines (with the exception of flu shots and other vaccines covered under Part B). ^[4] Medicare drug plans also cover certain brand-name and generic prescription drugs. Each drug plan has its own formulary, a list of approved drugs the plan will cover. These formularies are further broken down into “tiers” depending on their cost.^[4] Some drug plans require prior authorization before filling certain prescriptions, and can limit the amount dispensed at one time. In some cases, plans institute “step therapy” which means they may require patients to try one or more lower costing drugs before covering the prescribed, higher cost medication. ^[4]

Medicare Plan Finder

The Medicare Plan Finder will compare available plans by area. Information compared includes estimated annual drug costs, monthly premiums, deductibles and co-pays, drug coverage and restrictions, and an overall plan rating.^[5]

Medicare Part D Donut Hole

The Medicare Part D coverage gap, or “donut hole” is a temporary limit that is set on what the drug plan will cover. This coverage gap may occur if consumers spend a over a certain amount for covered drugs. Once in the coverage gap, consumers will receive a 50 percent discount on covered brand-name drugs and an 86 percent discount on generic drugs. To enable consumers in the gap to get out faster and resume normal coverage, the entire cost of brand-name drugs will count toward the out-of-pocket expense. ^[4]

Patient Assistance Program Overview

Also See: Patient Assistance Programs, Drug Coupons, FDA

References

1. ↑ ^{1.0 1.1} https://questions.medicare.gov/app/answers/detail/a_id/1/~/what-is-medicare%3F
2. ↑ http://www.medicare.gov/find-a-plan
3. ↑ ^{3.0 3.1} http://www.medicare.gov/Publications/Pubs/pdf/11111.pdf
4. ↑ ^{4.0 4.1 4.2 4.3} http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-d.aspx#WhatPartDplansCover
5. ↑ https://www.medicare.gov/find-a-plan/questions/home.aspx