Q: How can I be sure that my Medicare prescription drug plan will cover my expenses?
A: Generally, a prescription written by your doctor will be covered under your drug plan if you follow these requirements:
- Make sure your doctor is up to date on the prescription drugs your specific plan covers – each plan has a different formulary (covered drug list), which means your doctor may need to select a specific drug from among various options in the drug class.
- Be certain your doctor is aware of how much medication you are allowed under your plan to receive at a time.
- The doctor is required to prescribe lower-cost (generic) drugs rather than name-brand drug and must show that the drug he or she has prescribed is medically necessary.
Drug formularies change from one year to the next, and different Medicare Part D plans offer different levels of coverage for different drugs. So it’s important to shop around during open enrollment (October 15 to December 7) to make sure you’re enrolling in the plan that will provide you with the best coverage for the coming year. Medicare has a plan finder tool where you can enter your medications and see how much your out-of-pocket costs will be for each of the plans available in your area. If you’re currently taking medications, using this tool during open enrollment is essential.