Medicare prescription drug coverage, known as Medicare Part D, helps pay for your medications. You can enroll in Part D as a standalone plan or through certain Medicare Advantage Plans that include drug coverage.


What Does Part D Cover?


Each Medicare Part D plan has a formulary—a list of prescription drugs the plan covers. By law, every Part D plan must cover at least two drugs in each therapeutic category, and they are also required to cover all (or nearly all) medications in the following critical classes:

Anticonvulsants
Antipsychotics
Antidepressants
Anticancer medications
Immunosuppressants
HIV/AIDS treatments

Additionally, most Part D plans cover vaccines that help prevent illness or disease.

What’s Not Covered by Part D?

Certain medications and items are excluded from coverage, including:
Fertility medications and erectile dysfunction drugs
Drugs for cosmetic purposes (like hair growth)
Weight loss or weight gain drugs
Over-the-counter (OTC) medications

Understanding Part D Costs

Medicare Part D plans use a tiered pricing system, meaning medications are grouped by cost:

Tier 1—Lowest copayment, usually includes generic drugs
Tier 2—Moderate copayment, includes preferred brand-name drugs
Tier 3—Higher copayment, includes non-preferred brand-name drugs
Specialty Tier—Highest copayment, includes high-cost specialty drugs

Your Rights Under Part D

Once enrolled in a Part D plan, you have important rights, including
The right to receive an explanation of your benefits
The ability to request an exception if your medication isn't covered
The option to ask for an exception to waive a coverage rule
The right to request a lower copayment for a necessary, high-cost drug if no suitable alternative is available

Need Help Finding the Right Drug Plan?

We’re here to help you choose the Medicare prescription drug plan that fits your needs and budget. Contact us today to get started.