Helpful Hints for Using Your Medicare Drug Plan

There is a lot of helpful information available on finding the right Medicare drug plan, but not a lot on the best way to use the plan that you have. Join us as we go over some helpful hints on the best way to use your Medicare drug plan!

Transition Period

Did you know there are Transition Requirements that drug plans must follow during the first 90 days that you have the plan or if your plan had a formulary change that affected one of your drugs?

Transition Period Rules

The drug plan is required to allow you to have one 30-day fill of a non-formulary drug during your first 90 days on a plan.

The Part D plan cannot apply the prior authorization rules, nor enforce the step therapy rules during these 90 transition days.This is done so that the member has time to try a new drug that is on the new drug formulary or get their physician to request an exception for a certain drug to be included in the formulary.

Formulary Exceptions

Did you know that you can request that your drug plan make an exception for drugs you take? This is called a Formulary Exception Request and works in the following ways:

  • You can request that your plan cover a drug that is not on the plan’s formulary. This usually requires the help of your doctor.
  • You can request that a drug on the formulary be covered at a lower tier because you cannot afford the price of the higher tier.
  • Each carrier has a form or an email address where you can request a formulary exception.
  • You can also appeal a decision on your request if you do not agree. This is done with a form found on the carrier’s website or by calling customer service and requesting the form.

GoodRx or Other Discounted Coupon plans

Did you know that you can use coupon plans along with your Medicare Part D drug coverage? These are usually free or at least have a free version. Most people I know use the free version of GoodRx. This can help you find the best prices for your drugs, sometimes you can finder them cheaper than they are on your drug plan!

It sometimes makes sense to look for a coupon if you take a medium-priced drug that applies to a drug deductible. There is often a significantly lower price with a coupon verses having to meet a drug deductible before you ever get to your co-pay on a Medicare drug plan. But it is a numbers game and you just have to add up the cost both ways and see which is best.

These coupon plans should not be used instead of purchasing a Medicare Part D drug plan because of the penalty involved if you go without Qualified drug coverage and later decide to join a Medicare drug plan. That penalty stays with you for as long as you are on Medicare. Read more about the Late Enrollment Penalty Here.

There are some drugs not covered by Medicare even though they are a prescription:

  • Drugs for weight loss
  • Drugs that promote fertility
  • Drugs for cosmetics or hair growth
  • Prescription vitamins
  • Drugs that are not FDA approved

Here is an example of using Goodrx to save money on a non-covered drug: Vitamin D2 (Ergocalciferol). The lowest GoodRx price for the most common version of ergocalciferol is around $9.45, 64% off the average retail price of $26.70. Try looking up one of your drugs just for kicks:

Have questions about anything related to Medicare? Give Terri a call or schedule an appointment now!