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Medicare Part D

Medicare Part D is prescription drug coverage. It is an optional, additional plan to Original Medicare and Medicare Advantage. Specific coverage options and costs depend on the plan and provider you choose. 

How Does Medicare Part D Work?

When choosing a Medicare Part D plan, you will have the option to choose one of five drug coverage lists known as formularies. A formulary is a list of prescription drugs that are grouped into certain categories, or tiers. These tiers are:

  • Tier 1: Low Copayment, Covers Preferred Generic Prescription Drugs
  • Tier 2: Slightly Higher Copayment, Covers Generic Drugs
  • Tier 3: A Bit Higher Copayment, Covers Preferred Brand Name Drugs
  • Tier 4: Higher Copayment, Covers Non-Preferred Drugs
  • Tier 5: Highest Copayment, Covers Specialty Drugs

To clarify, a copayment is a fixed amount you pay for a covered health care service after you’ve paid your yearly deductible. For example, you may have to pay $20 out-of-pocket for a certain drug.

Preferred drugs cost slightly less than non-preferred drugs because they are chosen specifically by your plan provider. If you need prescriptions outside of this chosen list, you will have to choose a non-preferred plan.

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What Should You Know About Medicare Part D?

When choosing a Medicare Part D plan, you will be faced with many likely unfamiliar terms. The list below includes important Medicare Part D terms you need to be aware of when searching for a plan:

  • Part B vs. Part D Prior Authorization Required (B/D): This drug may already be covered by your Part B plan.
  • Prior Authorization (PA): This drug requires your doctor’s approval before it is covered by your Part D plan.
  • Step-Therapy (ST): If your condition is treatable by two different prescriptions, you may be required to test one possible drug before the other drug is covered.
  • Dispensing Limit (DL): This means that your plan will not allow for more than a 31-days supply of this drug.
  • Limited Access (LA): This drug is only available at certain pharmacies. Speak with your doctor to find out if this drug is available in your area.
  • Retail Only (RO): This prescription is only allowed to be filled in-person at a pharmacy.
  • Retail and Mail (RM): This prescription may be filled at a retail pharmacy or through the mail.
  • Specialty Pharmacy Only (SP): This prescription must be filled out at a specialty pharmacy. Speak with your doctor to find such a pharmacy in your area.
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A skilled Medicare professional should walk you through each of these terms according to your specific circumstances. MedicareMisty’s team of skilled agents will walk you through this process step-by-step to ensure that you are receiving the coverage you need at a price you can afford.

When you’re ready to start looking for a Medicare Part D plan, we have you covered. If you would like a free quote and help from one of our talented team members, give us a call at (423) 240-0794.