Does Medicare Cover Prescriptions?

Finding a health care plan that will cover your prescriptions is a key factor in preparing for retirement. Medicare prescription drug plans (Part D) cover a wide variety of prescriptions, including drugs in certain protected classes, those that treat cancer, and those that treat HIV/AIDs.

Each Part D plan has its own formulary, which provides a list of both generic and brand-name covered drugs. This list divides the plan’s covered prescriptions into different tiers, and each tier has a different cost.

Here’s an example of a typical Part D plan’s tiers:

  • Tier 1 (lowest copayment): most generic prescription drugs
  • Tier 2 (medium copayment): preferred, brand-name prescription drugs
  • Tier 3 (higher copayment): non-preferred, brand-name prescription drugs
  • Specialty tier (highest copayment): very high-cost prescription drugs

According to the the Food and Drug Administration (FDA), generic drugs are the same as brand-name drugs in:

  • dosage form
  • safety
  • strength
  • active ingredients
  • route of administration
  • quality
  • performance characteristics
  • intended use

Generally, all Medicare drug plans must cover at least two prescriptions per drug category, however, plans can choose which ones they will offer. Meaning, if the formulary does not include your specific medication, a similar one should be available in most cases. Using the medications covered on your plan’s formulary instead allows you to save money.

These plans are permitted to make changes to their drug availability throughout the year (even if you’re currently taking them) as long as they follow these guidelines:

  • They provide written notice at least 30 days prior to the effective change date.
  • When a refill is requested, written notice of the change and at least a month’s supply is provided under the same plan rules, prior to the change.

We understand how important it is to know that your prescriptions are covered by your Medicare plan. That’s what Medicare Part D is for. To find out more about Part D coverage and other Medicare options, give us a call at 1 (855) 665-9200 or contact your plan for its current formulary.

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