Retirement Planning – Factors to Consider in Your Medicare Drug Plan
Just because Part D is a prescription drug coverage plan, this does not mean that all the medicines you buy are covered. Companies who offer Part D have what is known as a formulary or a list of medicines that the plan covers. If you are on any maintenance medication, you should check if it is covered in the plan you intend to get.
Drug plans may also put certain coverage rules for all beneficiaries. One of these is prior authorization. You and/or your prescriber must contact the plan before certain prescriptions are filled. In some cases, your doctor may even need to show that the drug is medically-necessary. You may also be given quantity limits on how muchmedication you can get at a time. A common rule also put in place by drug companies is that of step therapy. Here, you are required to try one or more similar drugs which are cheaper (e.g. generic as opposed to branded medicines) before your plan will give coverage.
If you or your prescriber have reason to believe that you should not be bound by any of these coverage rules, you can contact the drug plan.