Which drugs do the Medicare plans cover?
How do I find out which Medicare Prescription Drug Plans cover my drugs?
Each Medicare Prescription Drug Plan will have a list of drugs it covers, called the plan’s formulary. The formulary is important to you because it will tell you three things:
- The names of the drugs the plan covers.
- How much you would pay for each drug. How much you pay depends on what co-pay “tier” the drug is on – see the section on co-pay tiers below.
- If there are limits or restrictions on your ability to get a drug.
The Formulary – List of covered drugs
The drug lists will include both generic and brand name drugs. Some drugs are on every plan’s formulary because Medicare requires it. There are also other drugs that the Medicare law says the Medicare plans cannot cover. Medicare must review and approve each plan’s drug list.
If your drug is not on your Medicare plan’s list, you will either have to pay full price for the prescription, or switch to a similar drug that the Medicare plan does cover. Or you can apply to the plan for an exception to see if your Medicare plan will cover the drug.
Co-pay tiers
Each Medicare plan places the drugs it will pay for in different levels, called tiers. Each tier has its own co-pay or co-insurance amount. Your drugs may be included in all the Medicare plans in your area, but they could be listed on different tiers with different co-pay amounts.
Most Medicare drug plans will have three to five tiers.
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