What does Part D cover?

Medicare Part D is the prescription drug coverage plan offered by Medicare. It can be purchased as a standalone plan with Original Medicare (Part A and B), or included as an extra benefit with a Medicare Advantage (Part C) plan.

Prescription coverage

Each Part D plan has a formulary, or list of prescription drugs it must cover. Each plan is required to cover at least two drugs in each class, as well as common vaccinations that prevent illness.
Also, each Part D plan must cover all of the prescriptions in these specific classes:
  • Immunosuppressants
  • HIV/AIDS drugs
  • Anticancer
  • Antidepressants
  • Anticonvulsants
  • Antipsychotics
Part D does not cover:
  • Medications that are covered by Original Medicare
  • Weight loss or weight gain drugs
  • Cosmetic drugs
  • Over-the-counter (OTC) drugs
  • Fertility or erectile dysfunction drugs

What are tiers?

Many Part D plans incorporate “tiers” on their formularies which indicate how much cost-sharing will be involved for a covered drug. Typically, a drug in a lower tier will cost less than a drug in a higher tier. There are five tiers:
  • Tier 1: Lowest cost – preferred generic drugs
  • Tier 2: Preferred generic drugs
  • Tier 3: Preferred brand drugs and non-preferred generic drugs
  • Tier 4: Non-preferred brand drugs and non-preferred generic drugs
  • Tier 5 (Specialty Tier): Highest Cost – high cost brand and generic drugs

Proinsurance Hawaii can help you find the right Part D plan

If you are in need of prescription drug coverage, then don’t wait. Proinsurance Hawaii can ensure you find the right Part D plan at the right price. Give us a call today!