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Understanding Medicare Prescription Drug Plans

Updated: Oct 26, 2021

First, I would like to wish everyone a Happy and Healthy 2020! The New Year for many is often viewed as a fresh start. In the world of Medicare prescription drug coverage, it can be a time of frustration as you fill your first prescription. Below, I am providing some general insights and a few tips for you to better understand Medicare prescrition drug plans. My hope is to alleviate any confusion and possibly even save you money this year on your medications. I hope you take the time to read it and that you find the information useful.

In 2020, the trend is plans with low premiums that have deductibles on Tier 3 Medications and higher. (Tier 1 and 2 generics do not apply, if using the preferred pharmacy or mail-order) If your plan premium cost is less than $72/month (currently the lowest cost plan without a deductible), you’re plan will have a deductible even if it did not last year.

TIP;Use your plans preferred Pharmacies. Most drug plans have preferred pharmacies. If you are not sure, you can find out online through the plans website, calling customer service or calling you agent. The difference in medicatio costs with standard vs preferred pharmacies can be substantial, especially when projected out over a year. Many plans will apply the deductible to Tier 1 and 2 generics if you use a standard pharmacy which is an unnecessary added cost.

TIP; Before you try and fill a new prescription, check to make sure it is covered by your plan. If your doctor submits prescriptions electronically, they will be able to check with your drug plan to make sure it’s covered. You can also provide a copy of your plan’s formulary to the doctor. No plan covers all medications, but all plans are required to cover at least two drugs per drug category. Which means the plan may not cover the specific drug you are being prescribed. Although there should be at least two similar medications available through the plan formulary. If that doesn’t work, your doctor will be able to submit and exception request directly to the plan. There are expedited exceptions depending on the need. Click here for details on Medicare drug plan coverage rules.

Brand medications are expensive! If you have a brand medication, we do not need to tell you about the high cost. There are also certain classes of medications that tend to be pricier than others. Hormone medications, dermatological creams,certain diabetes meds, and certain eye drops just to name a few. Click here to see a list of common brand drugs and thier average full drug cost. If you can avoid the drugs on the list provided by seeking an alternative through generic or like drug, we highly suggest that you do. Otherwise, you can expect to pay over $1000 in cost sharing for just one medication with a full cost of $450. If you take two drugs in that price range, your cost will jump to over $2500. Ouch!

As of fall 2019, the Medicare plan finder was overhauled. I assure you, it was not a seemless transition and left many agents scrambling to try and help people during the enrollment period. I am not a fan of excuses, however we are only as good as the information we can access. There were many errors in the website, but we all worked tirelessly in an effort to make sure our clients will have the best plans in 2020. We encourage all of you to establish your account, which allows you to view your medications, claims and your up to date Medicare card. This account can prove very valuable to you going forward.

I know we have covered a great deal of information. Ultimately, our agency is your local resource if you have questions on your drug plans. We don’t expect you to become an expert, but whenever possible we want to educate and empower our clients to make the best decisions with thier coverage!



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