Let’s Understand Prescription Drug Plans
Medicare Part D is the prescription drug program under Medicare. It was created by the Government but is run by private insurance companies.
The various plans offered have their own list of covered drugs which are called a “formulary.” These formularies are used to place drugs into different tiers based on the Medicare drug plans. Generally, a drug that is in the higher tier will cost you more than a drug that is in a lower tier. There are also some instances where your drug is placed in a higher tier and your prescriber believes you will require it versus something in a lower tier, exceptions can be granted for a lower co-payment.
During the year, some Medicare drug plans can make a change to its formulary within set guidelines from Medicare. If you are taking a drug that is involved in these changes you may have to provide a written notice 60 days before the date the change goes into effect. When you request a refill, you may also provide a notice of change and a 60-day supply under the same rules from the plan before the change.
Changes for 2016
For your prescriptions to be covered by your Medicare drug plan, your prescriber will need to enroll or file an “opt-out” request with Medicare for the prescriptions to be covered by your Medicare drug plan. The allotted time allows your prescriber to enroll or it gives you some time to find one that is currently enrolled. For more information visit medicare.gov or contact your plan or prescriber for additional assistance.
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