Medicare Part D: FAQs

 

  • Why do the plans change every year and cover only some prescription drugs?

All Medicare Part D plans are updated every year to ensure they meet new Medicare guidelines, as well as the needs of current members and those entering Medicare. Plan changes are based on the availability of new medications, manufacturer drug costs, inflation and other economic factors, changes in healthcare laws and annual changes the Medicare program requires of all Part D plans.

Medicare requires all Part D plans to cover a list of drugs, certain vaccines and certain diabetes supplies. When evaluating whether to add a new drug, plans consider factors such as standards of practice and scientific evidence, medical literature, accepted clinical guidelines, the drugs' safety and effectiveness and the availability of formulary alternatives.

 

  • Why do plans change the drugs they cover as well as the Tiers?

All Medicare Part D plans update their formulary annually. Formulary and Tier changes are usually in place when the plan year begins.

However, changes may occur at other times as new drugs or generics become available, or safety issues result in immediate removal from the market. If a specific drug isn't covered or its coverage changes, in most cases a similar drug or generic version, will be covered.

 

  •  Why do some plans have a deductible while others do not?

Some plans have a deductible as a means to offset higher drug costs, inflation and/or operating expenses. Other plans offer $0 deductible plans with affordable premiums, by operating efficiently and effectively negotiating with drug companies for lower prices.