Medicare

Which Drugs are Covered Under My Medicare Part D Plan? An Introduction to Medicare Formularies.

The list of drugs covered by a prescription drug plan is called a formulary. This is a plain-text explanation of why it is important when you choose a plan.

 
 

This is important to you because you want to choose from plans that include coverage for your prescriptions.

The list of drugs covered by a prescription drug plan is called a formulary. The drug list is different from plan to plan. Medicare rules require every plan to include drugs in each of six critical therapeutic categories, but the specific drugs covered is different from plan to plan.

This is important to you because you want to choose from plans that include coverage for your prescriptions.

It works like this: If your doctor has prescribed irbesartan (as an example), and your research finds five plans include that drug in their formulary, and 10 plans don't, you'd probably want to consider the five that have the coverage.

If you take multiple prescriptions.

If you take multiple prescriptions this process becomes more complicated. You could start by looking for plans that cover ALL your prescriptions. But wait, there's more: the monthly premium cost is a major factor that needs to be included in your consideration.

In our opinion as non-expert, everyday people, we think you must add the cost of your share each month for your prescriptions PLUS the monthly insurance premium, and compare the total annual costs.

You should consider the quality rating of the plan as well; that's the star-rating.

Still more factors...

Checking the formulary is a start, but there are a lot of other factors that come into play in Medicare Part D. You could be in the coverage gap called the "donut hole". Or you might have a disease that puts you in the Special Needs class. Or any of the other factors we still haven't explored. Those are topics you should explore here and elsewhere on the 'net.

Finding A Part D Formulary or Drug Information On-Line

Part D formulary clip This is a clip from an actual Medicare Part D formulary, on-line as a pdf document. It is basically a long list, on many pages, of prescription drug names. The "drug tier" column refers to the amount of coverage for each drug. The "requirements and limits" refers to this plan's special regulations.

Medicare.gov clip This is a clip from the page at Medicare.gov where you enter your prescription drugs in order to build a list of your prescriptions before using Medicare.gov to search for plans in your area.

According to the site "This will help us estimate your costs and allow you to see which plans cover your drugs. The site doesn't show pricing for over the counter drugs or diabetic supplies (e.g. test strips, lancets, needles)."

This link will take you to the page which starts the Plan Finder at Medicare.gov

The clip below is from Q1 Medicare.com. It lets you enter your prescriptions and see plans that include your drugs.

formulary browser

Web pages and sites to provide more information:
  • Medicare: American Diabetes Association©
    www.diabetes.org/living-with-diabetes/health-insurance/medicare.html

    source: American Diabetes Association
    languages: English, Spanish
    Basic info about all parts of Medicare, with a focus on diabetes care, supplies, and insulin.
 
DibbernsWhy this website?

We are a family of senior adults, with all the health issues of the average older American. Medicare has been a factor in our lives, as it is for millions of people like us. This website exists to offer plain talk, simple introductions to the maze of details that make up the Medicare program.

We aren't experts- we'll leave that to the real experts-- for the more complicated rules and issues of Medicare. What you'll find here is a beginning point. A start in your Medicare journey.

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Medicare & You Where is this topic in 'Medicare & You 2015'?
 

Look for the heading "Which drugs are covered?" at the top of page 106.

You should have received a copy of 'Medicare & You 2015' in the mail. If you don't have your copy, call 800-803-7174. Download a pdf version.

This video is from the US Government Centers for Medicare & Medicaid Services. It is a step by step overview on how to complete a plan search in multiple videos. This one explains using the formulary to enter your drugs. (Opens in a new tab.)

Medicare and Diabetes the news...

A possible alternative to Standard Medicare for people with diabetes

We can't go thumbs-up or thumbs-down on this, but it might be worthwhile to explore. There are special Medicare Advantage (Part C) policies that provide coverage for medical and prescription expenses for people with specialized health needs like diabetes. They are called Medicare Advantage Special Needs Plan (SNP). Be careful, these policies can be complicated.

Here's a link to a news story in The Clarion Ledger of Jackson, MS: Medicare plan offers help for seniors with diabetes