Medicare: Part D Prescription Drug Coverage

[Video Description: The post has a video thumbnail with blue shading overlaid. The top middle has "Medicare: Part D Prescription Drug Coverage” in white text with light blue background, accompanied by a yellow bubble with “Medicare” in blue. In the video: A nonbinary person with long, curly brown hair stands in front of the camera. Behind them is a light brown leather couch and a blue built-in bookshelf wall. They are wearing black pants, a dark maroon long-sleeve top, a long gray vest, and maroon glasses. 
 

Transcript: What medications are covered under Medicare Part D? Medicare Part D covers prescription drug coverage and helps you pay for medications. All Part D plans must cover all drugs available in the following categories: HIV/AIDS treatments, antidepressants, antipsychotic medications, anticonvulsive treatments for seizure disorders, immunosuppressant drugs, and anticancer drugs. Part D plans must also cover at least two drugs from other drug categories, or groups of drugs that treat the same symptoms. The plans are required to cover a wide range of medications, both generic and brand-name drugs. Part D plans must also cover most vaccines, unless covered by Part B. Vaccines are free under Medicare. There should be no copay, coinsurance, or deductible. Part D may also cover insulin and medical supplies used to inject insulin. There are some Part D plan rules that can limit medication coverage, including prior authorization, quantity limits, and step therapy. If prior authorization is required, you and/or your prescriber must contact the drug plan before you can fill the prescription. You may need to show that the drug is medically necessary for the plan to pay for the medication. Quantity limits also impose limits, or the maximum amount of medication you can get within a specific time period, such as per month. Step therapy may require you to try lower-cost drugs first before the plan covers your prescribed drug. You may receive a denial, also known as a “coverage determination” stating that your medication does not meet Food and Drug Administration (FDA) standards. If you receive a denial, you have a few options. You can work with your provider to ask for an exception, file an appeal, or pay out of pocket for the medication yourself. Sometimes individuals ask for an exception to the plan’s coverage if they need a medication that’s not covered, they believe that a rule, such as prior authorization should be waived, or they think that they should pay less for a more expensive mediation because the patient or provider believe that less expensive drugs cannot be taken for the same medical condition. You have the right to ask for an exception. If your network pharmacy cannot fill a prescription, pharmacies are required to provide you with the information you need to request an exception from your plan. You can work with your prescriber and complete the necessary forms to request an exception. Over-the-counter medications that are usually not covered Part D plans include: vitamins, minerals, or supplements; any medications for cosmetic or weight loss reasons; medications used to treat cold or cough symptoms; and most other non-prescription drugs. Not sure if your plan covers the medications you need? You can ask questions during open enrollment, such as: Are the medications I’m currently taking covered? How much will I pay monthly for covered medications, and for uncovered medications? Can I choose my pharmacy? Is there a mail-order pharmacy option? What out-of-pocket costs should I be aware of? Does the plan have coverage in multiple states? [The screen fades to show a thumbnail of a faded white background of a doctor holding hands with another individual] Deaf. Healthy. DeafHealth. Learn more at www.deafhealthaccess.org. [The screen fades to show a thumbnail of a blue lighthouse] Paf. Patient Advocate Foundation. www.patientadvocate.org.]