Prescription Drug Coverage
Part D prescription drug plans are administered by private insurance companies that have contracted with Medicare to provide Part D benefits. Only qualified insurers can sell these plans, so be sure to avoid sellers who are not licensed. Part D plans cannot be purchased if you have a Medicare Advantage plan, instead, you must seek prescription drug coverage through your provider or another insurer.
Part D Formulary
Each insurer tailors their policies based on what they wish to offer. Every Part D plan has a formulary that is a list of drugs that are covered. The different drugs are separated into different tiers based on cost and other factors. Every Part D plan must offer access to at least two drugs in each major category.
If you have a Part D prescription drug plan, your insurer must cover all drugs from the following categories:
- Anticonvulsive treatments for seizure disorders
- Immunosuppressant drugs
- Anticancer drugs (unless covered by Part B)
- Antipsychotic medications
- HIV/AIDS drugs