The costs for my medications was to the point I could not afford them all and the Doctor put me on another that I needed. The lady at the drug store told me to call Russ and see if he could help me. He showed me a way to lower my costs to less then what I paid before the new one. Now I don't have to worry if I can take what I have to.
Hugo L
Prescription Drug Plans (Part D)
Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan (Part D) when you're first eligible, or if you decide not to join a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, you'll likely pay a late enrollment penalty unless you have other creditable prescription drug coverage, or you get Extra Help.
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
2 ways to get drug coverage:
Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Medicare Advantage Plan (Part C) (like an HMO or PPO) or otherMedicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance)and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
What Drug Plans Cover:
Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your provider thinks you need that drug instead of a similar drug on a lower tier, you or your provider can ask your plan for an exception to get a lower copayment.
A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
2 ways to get drug coverage:
Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Medicare Advantage Plan (Part C) (like an HMO or PPO) or otherMedicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance)and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
What Drug Plans Cover:
Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your provider thinks you need that drug instead of a similar drug on a lower tier, you or your provider can ask your plan for an exception to get a lower copayment.
A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
- Provide written notice to you at least 60 days prior to the date the change becomes effective.
- At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change.
What are drug plan tiers?
Most of the medications on a drug list are grouped by tiers so members can easily find out if their health plan covers specific prescription medications. The least expensive and most effective drugs are in the lower tiers.
- Tier 1– Generic: Most drugs in Tier 1 are generic and have the lowest possible copayment. Drugs listed as Tier 1 are preferred because they offer the best combination of value and effectiveness. Some plans have a Tier 1A with preferred generics and a lower copay, and a Tier 1B with generic drugs with a higher copay.
- Tier 2 –Preferred Brand: Tier 2 includes non-specialty, preferred brand-name drugs that are more expensive than generics, and members pay a higher copay for them.
- Tier 3– Nonpreferred Brand: Tier 3 is made up of non-specialty, brand-name drugs for which there’s either a generic alternative or a more cost-effective, preferred brand-name drug available. Members pay a higher copay for these nonpreferred brand-name drugs.
- Tier 4– Preferred Specialty: This tier consists of specialty drugs, both generic and brand-name, that are used to treat complex health conditions. These drugs are generally more effective and less expensive than other specialty drugs.
- Tier 5– Non-preferred Specialty: Tier 5 is made up of specialty drugs that have more cost-effective generic or preferred alternatives available. Tier 5 drugs have the highest copayment.