Medicare prescription drug plans, also known as Medicare Part D, provides coverage for your prescriptions. These may be purchased as a standalone plan or may be an additional benefit in some Medicare Advantage Plans.

Coverage
Every Medicare Part D plan will have a formulary, also known as a list that describes the prescriptions the plan will cover. Medicare requires that Part D plans have to cover two drugs from each class. Part D plans must also cover all, if not most, of the prescription drugs in these specific classes:

• Anticonvulsants
• Antipsychotics
• Antidepressants
• Anticancer
• Immunosuppressants
• HIV/AIDS drugs

Part D plans will also cover vaccines that are used to prevent disease or illness.

A Medicare Part D plan will not cover:

• Fertility drugs or drugs for erectile dysfunction
• Drugs for hair growth
• Drugs for weight loss or weight gain
• Drugs for cosmetic purposes
• Over-the-counter drugs

Costs
Part D plans will typically add the prescriptions they cover into a tier-system. The prescriptions in each tier will have a different cost, but those in a lower tier will cost less than those in a higher tier. An example of a tier-system would look something like this:

• Tier 1—Has the lowest copayment with the most generic prescriptions.
• Tier 2—Has a medium copayment with preferred and brand name prescriptions.
• Tier 3—Has a higher copayment with non-preferred and brand name prescriptions.
• Specialty Tier—Has the highest copayment with very high costing prescriptions.

What rights do you have?
Once you have a prescription drug plan, you will have several rights that include:

Get an explanation from your drug plan about your benefits.
Ask for an exception if you need a prescription that is not covered by your plan.
Ask for an exception to waive a coverage rule.
Ask to get a lower copayment for a high-costing prescription that your prescriber deems is necessary and cannot be substituted for a cheaper alternative.