What is Medicare Part D Coverage?
Medicare Part D is an optional plan that you can add to your existing Medicare plan that covers prescription drugs. Part D covers a wide array of medicine and even covers prescriptions for ailments such as cancer and HIV/AIDS. Different plans have different formularies, and each formulary comes with its own categorization for prescriptions.
Policyholders will have a list of both brand-name medicine and generic brands. If you are considering a Part D drug plan, be sure to go over the list of medicine you may need to ensure you are getting the most cost-effective plan.
Those who suffer from an opioid use disorder can also get coverage for treatments. For instance, medicine such as methadone and buprenorphine can be covered for pain. Methadone is often used to help those with this disorder who are inpatients in a hospital. Medicare Part A and Part B can cover these medicines when it is used through an opioid treatment program.
Additionally, those who require insulin for ailments such as diabetes could save money on their insulin. Depending upon the plan and the available savings, policyholders could pay no more than $35 for a month’s supply. During open enrollment, be sure to discuss with your agent from Golden Plan Choice how you can save money on your drug plan and what prescriptions may be covered.
What Are Formularies And Medical Exceptions?
A formulary is a particular plan’s list of prescriptions that are covered. When a health care provider prescribes medication, they often fall under a particular class and category. Each formulary includes at least two medications from the most common classes. Therefore, most people will be able to find the drug they take on one of Medicare’s lists of covered medications.
If your particular medication is not on a list, there is usually an alternative that most people are able to take. If for some reason, a health care provider deems it necessary that their patient take a specific drug that is not on the list of covered medication, there are exceptions.
Exceptions must be formally requested and sent in for approval. An exception is a drug plan’s decision to cover a particular medication. There is a formulary exception and a tiering exception. A formulary exception is a drug plan’s ruling on a specific medicine that is not on the drug list or to waive a coverage rule. A tiering exception is a plan’s ruling to lower the price that is on the non-preferred drug tier.
With each exception, the patient or the prescriber (doctor or other legal health care provider allowed to write prescriptions) must put in a request. This request must also include a written statement by the prescriber stating why this exception is needed.