What Part D Covers

Part D offers prescription drug coverage for Medicare beneficiaries. 

Each plan gives a standard level of coverage set by Medicare. Plans have a list of prescription drugs they cover and place drugs into different “tiers” on their formularies.

Drugs that Part D covers

Plans include both brand-name prescription drugs and generic drug coverage.

Each plan’s formulary includes at least two drugs in the most commonly prescribed categories and classes. All Medicare drug plans generally must cover at least two drugs per drug category.

If your plan doesn’t include a drug you need, it usually will contain one that is similar. If your prescribing doctor believes none of the drugs on your plan’s formulary will work for your condition, you can ask for an exception.

The formulary can change

Your plan can make some changes to its drug list if drug therapies change, new drugs are released, or new medical information becomes available. You are allowed to file an exception if you feel you still need the drug being removed.

For changes involving a drug you’re currently taking that will affect you during the year, your plan must do one of these:

  • Give you written notice at least 30 days before the date the change becomes effective.
  • At the time you request a refill, provide written notice of the change and at least a month’s supply under the same plan rules as before the change.

Your plan can immediately remove drugs from their formularies after the Food and Drug Administration (FDA) considers them unsafe or if their manufacturer removes them from the market. If you’re currently taking any of the drugs immediately removed, you’ll get information about the specific changes made afterwards.

What are the tiers?

Each plan can divide its tiers in different ways. However, each tier costs a different amount. Usually, a drug in a lower tier will cost you less than a drug in a higher tier.

If your drug is in a more expensive tier and your doctor thinks you need that drug instead of a similar drug on a lower tier, you can file an exception and ask for a lower copayment.

Are the generic drugs safe?

According to the Food and Drug Administration (FDA), generic drugs are copies of brand-name drugs and have the same:

  • dosage form
  • safety
  • strength
  • route of administration
  • quality
  • performance characteristics
  • intended use

Generic drugs use the same active ingredients as brand-name prescription drugs. Generic drug makers are required to prove to the FDA their product works the same as the brand-name prescription drug.

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