MEDICARE PART D

Medicare PRESCRIPTION COVERAGE

Part D will help pay the cost of prescription drugs that are on the health plan’s Part D formulary. You must choose whether or not to enroll in Part D and there are penalties for late enrollment.

Private health plans offer this coverage, but original Medicare does not, and there is an additional monthly premium for this coverage.

If you choose to enroll in a Medicare supplement then you are required to take out a stand-alone part D plan.

If you enroll in a Medicare advantage plan then chances are you part D plan will be included.

If you enroll in a cost plan then you are often given the option of including your part D as part of the plan or enrolling in a seperate, stand-alone one.

Part D Penalty - LATE ENROLLMENt

You are required by Medicare to sign up for part D coverage either:

• during your 7 month IEP window (3 months prior to the month you turn 65, the month you turn 65, and 3 months after the month you turn 65)

  or

• within 63 days of dropping or losing your group plan after having delayed going fully onto Medicare when you were first eligible.

If you enroll outside of these two “windows” you may incur a part D penalty which is 1% of the national part D premium average for every month you didn’t have one and is assessed every month for the rest if your life.

UNDERSTANDING YOUR FORMULARY

Medication Therapy Management (MTM program)
Maximize your medication therapy results and minimize your out-of-pocket drug costs with the help of a pharmacist who will become your personal resource and advocate at no additional cost to you.

Step Therapy Program
Step Therapy focuses on encouraging the use of cost-effective drugs as first line treatment when therapeutically appropriate. Certain drugs are grouped in a logical series of steps that a doctor can follow with treatment.

Transition of Care
In many cases, The Plan will cover up to a one-month transition supply for Part D drugs not on our formulary, no longer part of our formulary or if access to the drug is limited.

Drug Exceptions and Prior Authorizations 
If a drug is not covered by The Plan formulary or has coverage restrictions you can submit an exception request to have your drug covered or have restrictions waived. If a drug is not removed from The Plan formulary, or if prior authorization, quantity limits and/or step therapy restriction are added, The Plan will notify you of the change in advance

Formulary Exception
You can ask The Plan to make exception to the coverage rules

Cost Tiers
Each drug is categorized by Tier, which determines how much you will pay for that drug.