Medicare Prescription Drug Plans


Do you need to compare Medicare prescription drug plans each year during Open Enrollment or when first signing up for Medicare?

If you are using medication and some of your drugs are not generic it would be a good idea to compare plans. Most independent insurance carriers offer several Medicare prescription drug plans. If you have a Medicare Part C Advantage Plan that includes your drugs you cannot have a stand-alone prescription drug plan. You must use the drug plan included in the Advantage Plan.

Most prescription drug plans have 5 tiers. Tier 1 is preferred generic with the lowest cost and goes up to tier 5 which are specialty drugs at the highest cost. The commonality between drug plans is that one plan may have your drug in tier 3 and another plan could have the same drug in tier 2. There could be a big savings depending on the drug and frequency of use.

If you are using a drug that is not currently in your prescription drug plan you can ask your doctor to submit an “Exception” for you. This could allow that particular drug be added to your formulary. Normally an “Exception” will be considered a tier 3 in your formulary.

Your agent should have your drugs on file so they can be checked each year if you are using other than generic drugs. You should also keep your agent informed each year of any changes in your drugs or if the drug plan notifies you of changes in their plan. It is best to be proactive and work with your agent.