What is Prescription Drug Coverage?

Medicare Part D is prescription drug coverage offered by Medicare-approved private companies. 

What Does Medicare Part D Cover? 

Medicare Part D coverage includes: 

• Brand name drugs 
• Generic drugs
• Vaccines 

Medicare Part D plans publish a list of all the drugs they cover called a formulary. This list is updated every year to make sure it includes the most effective drugs available.  

Your prescriptions need to be on the formulary to be covered by insurance. Some drugs come with additional requirements:  

• Your doctor may need to get prior authorization from your Medicare Part D plan before the prescription can be filled. 
• There may be a quantity limit. The plan might limit the total amount of a drug they will cover. Or, they might limit how much they will cover in a certain time period.
• In some cases, the plan will ask you to try certain drugs to treat your medical condition before covering another drug for that condition. That is known as step therapy.  

If your medication is not on the formulary, your provider may be able to help you find a similar drug that will work just as well. Your provider can also apply for an exception if he or she believes a specific drug is important to your health.   

Medicare Part D plans also have a list of pharmacies – including mail order options – that are in the plan’s network. You can get your medications from the pharmacies on the list from any location in the United States.  

What is Medication Therapy Management (MTM)?

Medicare Part D plans offer free Medication Therapy Management (MTM) services to help you use your prescriptions safely. MTM is for individuals who are taking more than one drug.  

In a one-on-one appointment, a doctor or pharmacist will review your prescriptions and answer any questions you have. They will also make sure you know how to use your prescriptions safely and check to make sure the medications are working together to improve your health.  

How Much Does Medicare Part D Cost?

To enroll in Medicare Part D, you have to be enrolled in Original Medicare or a Medicare Advantage Plan that doesn’t include prescription drug coverage. Your costs will include your premiums for those plans plus a Part D premium. You may also have a yearly deductible and copayments or coinsurance for your prescriptions.  

Learn more about the costs for Medicare Part D. 

Additional Medicare Part D Coverage Options 

If you enroll in Medicare Part D, you can also enroll in: 

• Medigap for supplemental insurance to help pay out-of-pocket expenses
• A Medicare Advantage plan that does not include prescription drug coverage 

Or, you can consider another option: 

• You can enroll in a Medicare Advantage plan that bundles Part A, Part B and Part D prescription drug coverage together into one plan. Some Medicare Advantage plans also include other health care benefits like hearing, vision and dental.  

Have Questions? Learn More from Banner Health. 

Learn about Banner Medicare’s Part D Plan. 

See Banner Medicare’s Formulary. 

See Banner Medicare’s Pharmacy Directory. 

Contact Banner Medicare so we can answer any questions you may have and even help you enroll.  

Call (888) 788-1931 (TTY 711) to speak with a licensed sales agent. 

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