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Part D


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Prescription Drug Coverage

Medicare Part D is your prescription drug plan. Since it’s a government program, it helps pay for prescription drugs that are approved by the Centers for Medicare and Medicaid Services (CMS). If CMS doesn’t approve your drug, it won’t be covered under Part D.

Watch this video to learn about signing up for Medicare Part D.

Drug Tiers

All CMS-approved drugs in the list are grouped into tiers. Your copayment for each prescription drug depends on its tier ranking. Talk with your doctor if your drug isn't on the drug list or is in a higher tier. All plans have an exception process and allow you a transition period of 30-90 days. During this time, you and your doctor can talk about other drugs or ask for an exception.

Utilization Management (UM)

UM is used in Part D to make sure you’re on the right path. During this review, your prescribed drug is compared to treatment guidelines to make sure your meds are right for you. A few examples include:

  • Step Therapy — calls for using one or more set drugs before higher doses can be used
  • Quantity Limits — sets supply or number of units limits based on scientific and clinical reasoning
  • Prior Authorization — calls for standards to be met before a drug is covered

Help with Payments

You may qualify for lower prescription drug costs if you have modest earnings and fixed assets. Visit the Social Security Administration website for details and forms.