Medicare Part D Plans are prescription drug plans that you can purchase separately from your Original Medicare coverage. Some Medicare Advantage (Part C) plans also offer prescription drug coverage as one of their added benefits.
Each Part D plan has a formulary, or list of drugs, that it covers. These formularies vary across each plan, so comparing your plan options before enrolling is crucial in getting the prescription drug coverage you need. However, even after enrolling in a Part D plan, plans can always change. Granted, they must always give you a notice if they do so, but if you have a Part D plan that notifies you of changes to its formulary or even cost, you may be wondering what you can do.
Fortunately, you have options if you need to switch Part D plans.
Opportunities To Make A Change
You can enroll in, change or disenroll from a Medicare Part D plan each year during the Medicare Annual Enrollment Period (AEP). This period takes place each year from October 15 through December 7. Changes made during this time will be effective January 1 of the following year. Part D plan options can be found on www.medicare.gov, along with the CMS star ratings for each drug plan.
There are a few other times when changes can be made to a Part D drug plan, such as:
- If you qualify for the Extra Help program.
- If you are eligible for a Special Enrollment Period (SEP) that impacts your drug coverage. For example, if you lose drug coverage equal to or better than that offered by Medicare (known as creditable coverage), or your drug coverage is reduced to a level below that of Medicare’s.
- If you are able to switch to a five-star plan.
What If I Never Enrolled In Part D?
If you didn’t enroll in Part D coverage when you were first eligible for Medicare or don’t have creditable prescription drug coverage for 63 days or more, you will have to pay a late enrollment penalty once you join a Part D plan. This penalty is permanent and will last for as long as you have Medicare.
List of covered prescription drugs – formulary
Most Medicare drug plans (Medicare drug plans and Medicare Advantage Plans with prescription drug coverage) have their own list of what drugs are covered, called a formulary. Plans include both brand-name prescription drugs and generic drug coverage. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes. This helps make sure that people with different medical conditions can get the prescription drugs they need. All Medicare drug plans generally must cover at least 2 drugs per drug category, but plans can choose which drugs covered by Part D they will offer.
The formulary might not include your specific drug. However, in most cases, a similar drug should be available. If you or your prescriber (your doctor or other health care provider who’s legally allowed to write prescriptions) believes none of the drugs on your plan’s formulary will work for your condition, you can ask for an exception.
A Medicare drug plan can make some changes to its drug list during the year if it follows guidelines set by Medicare. Your plan may change its drug list during the year because drug therapies change, new drugs are released, or new medical information becomes available.
Plans offering Medicare drug coverage under Part D may 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. Plans meeting certain requirements also can immediately remove brand name drugs from their formularies and replace them with new generic drugs, or they can change the cost or coverage rules for brand name drugs when adding new generic drugs. If you’re currently taking any of these drugs, you’ll get information about the specific changes made afterward.
For other 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.
You may need to change the drug you use or pay more for it. You can also ask for an exception. Generally, using drugs on your plan’s formulary will save you money. If you use a drug that isn’t on your plan’s drug list, you’ll have to pay full price instead of a copayment or coinsurance, unless you qualify for a formulary exception.
All Medicare drug plans have negotiated to get lower prices for the drugs on their drug lists, so using those drugs will generally save you money. Also, using generic drugs instead of brand-name drugs may save you money.
For more information feel free to contact us at (800) 414-2044