Part D Prescription Coverage

Every plan has its own list

Part D plans each publish a formulary, which is the list of drugs they cover and the tier each drug sits on. Two plans in the same county can both cover your medication and still treat it completely differently, because one puts it on a preferred tier and the other does not.

This is why generic advice fails

There is no plan that is cheapest for everyone, because the answer depends entirely on which specific drugs you take. A plan that is excellent for your neighbor can be a poor fit for you over one medication. The only way to know is to check your actual list, by name and dose, against each plan's formulary.

Things that change the answer

• The pharmacy you use. Many plans have preferred pharmacies where the same drug costs less.
• Mail order. Often priced differently from retail for maintenance medications.
• Quantity. A 90-day fill is not always three times a 30-day fill.
• Prior authorization and step therapy. A drug can be covered but require approval first.

Extra Help

There is a federal program that assists people with limited income and resources in paying for Part D. Many people who would be eligible never apply. If money is a factor, ask about it directly rather than assuming you would not qualify.

Check it every year

Formularies change every January. A drug that was on a preferred tier this year may not be next year, and your plan is not going to call you about it.