Medicare Part D Prescription Drug Plan
What AreMedicare Part D Plans?
Medicare prescription drug coverage is a stand-alone drug plan that adds prescription drug coverage to the Medicare Parts A&B (also known as “Original Medicare”). Part D Medicare prescription drug coverage covers both brand name and generic prescription drugs offered at participating pharmacies.
Although most plans do not cover each and every drug, Copeland Insurance Group ensures that we have extensive plans that cover the majority of personal prescription drug needs.
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UnderstandingMedicare Part D
There are two types of Medicare Part D Coverage:
- Stand-Alone Plans, also known as PDPs (Prescription Drug Plans), which only offer prescription drug coverage.
- MAPD (Medicare Advantage plus Prescription Drug) Plans that offer prescription drug coverage along with medical health coverage for visits to the doctor and for hospital expenses.
Starting in 2011, an individual enrolled in a Medicare Advantage plan (part C) can return back to the Original Medicare and a stand-alone Part D plan during the first 45 days of the year. This 45 day period is the Medicare Advantage Disenrollment Period (MADP). The MAPD election period runs from January 1-February 14th each year.
The Annual Election Period for 2022 plans is October 15, 2022 to December 7, 2022
Which drugs will be covered, and on the drug list?
Part D plans commonly use a variety of prescription drug benefit management tools, including:
*A formulary: A list of drugs covered by the plan
Cost sharing tiers:
*Drugs may be grouped together by amount of cost sharing. Many plans group drugs into 3 or 4 tiers with lower tiers costing less than higher tiers, for example:
- Tier 1: Generic Drugs
- Tier 2: Preferred brand-name drugs
- Tier 3: Non-preferred brand-name drugs
- Tier 4: High-cost drugs
By law, Part D plans are permitted to cover any prescription drugs and biologicals that:
- Must be covered by states that provide Medicaid prescription drug benefits.
- Many Part D plans do not cover all of these drugs because in some cases several similar drugs are available to treat the same medical condition.
- Part D plans include the drugs they will cover on formularies that are developed by pharmacists, doctors, and other experts.
- Part D plan formularies must include:
- At least two drugs in each therapeutic category.
- Generic and brand-name drugs.
Medicare Part D Medication Therapy Management (MTM) programs seek to provide individuals taking medication for chronic diseases with an optimal regimen of treatment for their conditions.
All Medicare Part D sponsors are required to have a Medication Therapy Management (MTM) program with the exception of MA Private Fee for Service (MA-PFFS) and PACE organizations. Their MTM programs must be designed:
- to ensure that covered Part D drugs prescribed to a targeted beneficiaries are appropriately used; and
- to reduce the risk of adverse events, including drug interactions.
By law, Part D plans are not permitted to include the following under their Part D covered benefits:
- Drugs for weight loss or gain, fertility, cosmetic purposes, symptomatic relief of cough and colds
- Medical foods formulated to be consumed or administered entirely under the supervision of a physician that are not regulated as drugs under section 505 of the Federal Food, Drug, and Cosmetic Act
- Erectile dysfunction drugs (when used for sexual dysfunction)
- Non-prescription drugs
- Some off label use drugs
- Part B covered drugs
- Part D plans are permitted to offer supplemental benefits that cover certain drugs not covered under Part D