Prescription Drug Plans

What is Medicare Prescription Part D?

Medicare Prescription Part D, also known as “PDPs,” are plans that add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

Each Medicare Prescription Drug Plan has its own list of covered drugs, known as a formulary. Many Medicare drug plans place drugs into different “tiers” on their formularies, with drugs in each tier having a different cost. A drug in a lower tier will generally cost less than a drug in a higher tier. In some cases, if your prescriber believes that you need a drug from a higher tier instead of a similar drug from a lower tier, you or your prescriber can ask your plan for an exception to receive a lower copayment.

Medicare drug plans can make changes to their formularies during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must either provide written notice to you at least 60 days prior to the change becoming effective or provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change when you request a refill.