Your plan will provide you with a list of covered drugs:
- Many place these drugs into tiers, and costs vary by the tiers the drugs are in.
- You can ask for exceptions in certain situations if your drug is in a higher (more expensive) tier.
Plans may have one of these three coverage rules:
- Prior Authorization: You and your prescriber must contact the drug plan before you can fill certain prescriptions. You may need to prove the drug is medically necessary before it will be covered.
- Quantity Limits: Your plan may place a limit on how much you can get of any one drug within a certain time period.
- Step therapy: This is where your plan insists you try less expensive drugs before covering the more expensive options.
If you get your prescriptions auto-refilled in the mail:
- You should approve these before they are sent. If you get a prescription you don’t want, you may be eligible for a refund.
Medication Therapy Management (MTM) Program:
- This a program designed to help you understand your prescriptions. Medicare Prescription Drug Plans are required to offer these to members who meet certain requirements. The services included are free and usually include a discussion with a pharmacist or health care provider.
- Please call us if you feel this is something you feel you need. It’s very important you take your prescriptions correctly.
Your Part D coverage will most likely not work with other types of insurance coverage. Please contact our office you want to learn if Part D will work well with your current insurance coverage!