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Prescription Drug Coverage

Part D

AKA prescription drug coverage, can be purchased with a supplement or as a stand alone plan with original Medicare.  Part D plans are managed by Medicare and run by Private insurance companies. 

What are the costs?

 Costs for prescription drug coverage vary by monthly premiums and  a formula based system with preferred and standard pharmacies to calculate drug costs? 

What is a drug tier?

Part D drug plans and costs are rated by tiers set by CMS

Tier 1: Preferred generic drugs

Tier 2: Generic drugs

Tier 3: Preferred brand drugs and select insulin drugs

Tier 4: Non-preferred drugs

Tier 5: Specialty drugs

Four stages of drug coverage

1.  Deductible:  If you have a deductible, you pay 100% of your drug cost until you meet your deductible.

2. Initial coverage: You will pay a copay or a percentage of the cost, and your plan pays the rest for your covered drugs.

3. Coverage Gap:  aka the donut hole:  After you enter the coverage gap, you pay a percentage of the plan’s cost for covered brand name drugs and/or covered generic drugs until your costs total $7050.

4. Catastrophic Coverage: after your yearly out of pocket drug costs reach $7050, the plan pays most, or in some cases all, of your covered drug costs.

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