Des Moines, Iowa — In less than a month Medicare will announce the 2015 Part D prescription drug plans. “While cost is certainly an important factor, there are other important considerations in choosing a plan,” says Kris Gross from the State of Iowa’s Senior Health Insurance Information Program (SHIIP). “These other factors can affect what comes out of your pocket as much as the price of the drugs,” she adds.
The list of drugs a plan will cover is called the “formulary.” This list must include drugs in most commonly prescribed categories and classes, but not necessarily all drugs. Your specific drug may not be covered by a plan. If you or your doctor don’t believe any of the drugs on your plan’s drug list are appropriate, you can ask for an exception.
If a plan removes a drug you are taking from its list, you must be notified at least 60 days in advance. In most cases, if you have been actively taking the drug during the calendar year, you can continue taking it and the plan will cover it until the end of the year.
It’s also important to understand that plans may have coverage rules to make sure that certain drugs are used correctly and only when necessary. These rules may include prior authorization, step therapy, and quantity limits. Prior authorization means your doctor must first contact the plan and show there is a medically-necessary reason why you must use this particular drug before the plan will cover it. With step therapy you must first try certain less expensive drugs that have been proven effective for most people with your condition. Quantity limits may apply to certain drugs for safety and costs reasons. As you compare plans for 2015 check if any of these coverage rules will apply. Not all plans use the same rules.
Finding a plan that includes your pharmacy in its network is the other important factor. Your plan may not cover your prescription if you don’t go to a network pharmacy. You can check to see if a network pharmacy is a preferred pharmacy, where costs may be less, or if it offers 60 or 90-day programs where you can get 60 or 90-day supplies. Some plans offer mail-order programs that allow you to get up to a 90-day supply delivered to your home at cost-effective rates.
As you compare plans for 2015 include on your checklist the drugs covered (formulary), network pharmacies and coverage rules. For more information or questions on Medicare Part D plans, contact your local SHIIP Volunteer at Veterans Memorial Hospital at 568-3411. SHIIP is a service of the State of Iowa and does not sell or promote any insurance policy, company or agent. All services are free, confidential and objective.