What is a Formulary and Why is it Important?
- Each Medicare Part D prescription drug plan and Medicare Advantage plans with Part D still has its own list of covered drugs called a formulary.
- Similarities and Differences: All formularies follow federal guidelines, but they may not cover the exact same medications. They must include most types of drugs used by beneficiaries. The differences might impact which plan is best for you, so check if your needed medications are covered.
- Purpose: Formularies identify medically appropriate and cost-effective medications. They include both brand and generic drugs.
- Tiers: Many plans organize drugs into tiers based on cost. Lower tiers have lower-cost drugs. Plans decide which drugs go in each tier.
Important Updates:
- Tiering changes: As of January 2024, plans can have up to 7 tiers in their formularies, allowing for more precise cost differentiation.
- Notice of Formulary Changes: The requirement for plans to notify members of changes to their medications remains:
- Written notice at least 60 days in advance for changes affecting current medications.
- Written notice and 60-day supply at the refill request for certain changes.
- Prescription Costs: Copay, coinsurance, and deductibles still vary by plan and tier. It’s crucial to compare plans to find the most affordable option for your medications.
- Prescriber Enrollment: Most prescribers still need to be enrolled in Medicare or have an opt-out on file for your medications to be covered. A 3-month grace period exists for exceptional cases.
Additional Information:
- Resources:
- Medicare.gov: https://www.cms.gov/medicare/coverage/prescription-drug-coverage/formulary-guidance
- Medicare Drug Finder: https://www.medicare.gov/drug-coverage-part-d
Remember: Regularly review your plan’s formulary and costs to ensure it continues to meet your needs.
Photo by Tima
