Prescription coverage can be one of the most important—and easiest to overlook—parts of a Medicare review. A plan with a low premium could cost more overall if your medications are placed on expensive tiers or your pharmacy is not preferred by the plan.
Start with an accurate medication list
For each prescription, record:
Exact medication name
Dosage and form
Quantity
Refill frequency
Whether you require the brand-name version
Small differences matter. A tablet and an injection—or a 30-day and 90-day supply—can produce different comparison results.
Check the formulary
A plan’s list of covered medications is called its formulary. Each plan has its own formulary and places covered prescriptions into tiers that affect what you pay.
A prescription covered this year could move to another tier or receive a new restriction next year.
Look for restrictions
Common drug-management rules include:
Prior authorization: The plan must approve the medication before covering it.
Step therapy: You may need to try another medication first.
Quantity limits: The plan limits the amount it covers during a particular period.
Compare pharmacies
Plans may classify participating pharmacies as preferred or standard. Your cost could change based on where you fill a prescription. Compare your usual pharmacy with other local and mail-order options. Medicare advises that using certain pharmacies may save money.
Compare estimated annual cost
Your complete prescription expense can include:
Monthly premium
Deductible
Copays or coinsurance
Costs during different coverage phases
Applicable income adjustments or penalties
The lowest-premium plan is not necessarily the least expensive plan for your particular prescriptions.
Review coverage every fall
Even when your medications remain unchanged, a plan’s premium, formulary, tiers, restrictions and pharmacy arrangements may change.
Jared and Mandy Simms at Friendliest Agent help Medicare beneficiaries across Northwest Arkansas compare health and prescription coverage. Bring your complete medication list and preferred pharmacies to your appointment. Contact us for your personal consultation.
This article is for educational purposes and does not replace information from Medicare, your plan, pharmacist or healthcare provider. Formularies, pharmacies, restrictions, costs and availability vary.
Recommended links:
