Understand prescription drug coverage before you need it
Prescription drug coverage is commonly called Medicare Part D. It can help pay for many brand-name and generic medications, but the drugs covered, pharmacies available, and costs can vary.
A useful starting point is to keep an up-to-date list of your medications and the pharmacies you prefer to use.
Prescription drug coverage uses a list of covered medications
Medicare prescription drug coverage, also called Part D, can help pay for brand-name and generic medications. Each plan has a list of covered drugs, sometimes called a formulary.
A medication may be covered differently from one plan to another. The pharmacy you use can also affect what you pay. Keeping an up-to-date list of your medications, doses, and preferred pharmacies can make it easier to use official Medicare information.
A covered drug may still have coverage rules
A plan’s list of covered medications is called a formulary. Plans can place medications in different cost levels, often called tiers. A drug in one tier may have a different cost than a drug in another tier.
Some medications may also have coverage rules, such as prior authorization, step therapy, or quantity limits. These rules do not necessarily mean you cannot receive a medication, but they can affect the steps needed before coverage applies.
If you take a medication regularly, review the plan’s official drug information and ask your prescriber or pharmacist when you have questions about coverage rules.
Keep these three things together
Your medication list
Write down each medication’s name, dosage, and how often you take it. Include both brand-name and generic medications.
Your preferred pharmacies
List the pharmacies you prefer to use, including mail-order options if that is something you use.
Questions to research
Note any questions about your medications, coverage, pharmacies, or potential out-of-pocket costs.
Keep your prescription information up to date
Medication needs can change over time. Your list should include new prescriptions, changed doses, medications you no longer take, and the pharmacies you prefer to use.
When you have Medicare drug coverage, keep your plan card with you when filling prescriptions. If you have a question about a medication, pharmacy, or what you may pay, your plan and pharmacist can help explain the information that applies to your coverage.
Questions worth writing down
Before reviewing Medicare prescription drug information, it can help to make a short list of questions that matter to you:
- Are all of my current medications on the plan’s covered drug list?
- What pharmacy options are available to me?
- Could the pharmacy I use affect what I pay?
- Are there coverage rules for any of my medications?
- What might I pay for regular prescriptions?
- Who can help explain a coverage question about a medication?
Writing down your questions can make it easier to use official Medicare information and have a more productive conversation with your pharmacist, prescriber, or plan.