Medicare - What Is A Formulary?

A formulary is a list of prescription drugs that are covered in a stand alone Medicare Prescription Drug plan (Part D) or Medicare Advantage plan (Part C) that has prescription drug coverage included. (Note: Not all Medicare Advantage plans have prescription drug coverage included.) 

Each Medicare Prescription Drug plan (Part D) and Medicare Advantage plans, that have prescription drug coverage, have their own specific formularies. If your prescription is not in the formulary of the Medicare Insurance plan you choose, then it is not covered. So it is very important to look up all your prescriptions within the specific plan you choose in advance before you decide to enroll in that specific plan. Formularies can not only vary just from one insurance company to another insurance company, but also can vary within the same company by different plans. So don’t assume all your drugs are covered just because your drugs were listed in the formulary of an insurance company in one plan, but then you decide to switch to another plan within the same company. Since they could have a different formulary for that other plan even though it is through the same insurance company and possibly some of your drugs may not be covered under that different plan. In addition, even if all your drugs are covered in one plan and are also still covered in another plan you choose, verify the tier levels for each of your drugs are the same. Tier levels can vary from one plan to another. Many Medicare Insurance plans place drugs into different tier levels within their formularies. Drugs in each tier level can have different costs. Generally the lower the tier level, the lower the copay for the member, with some exceptions. Be sure to find out the tier level and copays for each of your drugs. Also check to see if there is a deductible in your drug plan and if so, how much. Since some plans (but not all) require you to pay a deductible for your drugs before any drug benefits kick in. 

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