Medicare Part D Formulary lists show you what you can expect to pay for your prescription drugs if you are already a Part D participant. Because the drugs accepted by Medicare are placed into separate categories or tiers, you can expect to have separate Medicare insurance plan co-pays for each drug that you take. If you understand these tiers for the Medicare Part D Formulary lists, then you will be able to better understand what kind of prescription drugs are covered by your Part D coverage. In the long run, you will be able to save money by choosing the drugs that are placed in the less expensive tiers.
Each tier of the Medicare Part D Formulary list is numbered: Tier one, two, three, four, and five. Most formulary lists consist of three to five tiers. The general rule of thumb for these formulary lists is that if the prescription drug is set up in a lower tier then the co-pay paid by the Medicare patient for that prescription drug will be less. Thus if the prescription drug is set up in a higher Medicare Part D Formulary tier, then the Medicare Patient will need to pay a higher co-pay. Once you develop a better knowledge of these tiers, it will be much easier for you to distinguish which of your prescription drugs are going to be placed in the lower and higher Medicare Part D Formulary tiers.
The first tier of the Medicare Part D Formulary list is Tier One. Since this tier is the lowest one, then the out of pocket co-pay for the patient is going to be the lowest on prescription drugs that are contained in this list. For example, the co-pay for the drugs in the first tier of the list can range anywhere from five to ten dollars per prescription drug. This formulary usually deals with the kinds of prescription drugs that are called preferred, generic drugs. That means that these drugs are a Medicare approved or preferred drug, and that the drugs themselves are the generic brand.
Tier two is the second tier. Since this tier is a little bit higher than the previous tier, the prescription drugs that are placed into this formulary are going to cost the patient a little bit of a higher co-pay as part of their coverage. Therefore if your co-pay for tier one is five to ten dollars per drug, then your co-pay for a drug out of tier two could possibly be twenty to thirty dollars per prescription drug. The drugs that will qualify to be in the tier two of the list are the preferred, brand name drugs. These prescription drugs will be very similar to the tier one drugs, but the patient will be paying more for the name brand version of the prescription drug.
As the tiers get higher so does the co-pay for the branch D patient. Therefore tier three is going to be slightly higher than tier two. This tier of the Medicare Part D Formulary will deal primarily with the drugs that are listed by Medicare as non-preferred. To find out which of your prescription drugs are non-preferred by your plan, you simply would need to ask you medical doctor or your pharmacists. They should be able to tell you if any of your prescriptions are non-preferred. This will help you so that you will not be surprised if you are required to pay a higher co-pay of maybe forty to as high as a hundred dollars per prescription drug.
The fourth and fifth tiers are going to be the highest tiers that your prescription drug can be placed into by the Medicare Part D Formulary lists. That means that the prescription drugs that are placed in this category are going to have the most expensive co-pay for the Medicare patient to pay. Prescription drugs placed in the formulary will generally be considered specialty prescription drugs that are usually very expensive on their own. The Part D co-pay for these prescription drugs could be anywhere above the one hundred dollar mark per prescription drug.
As a Part D patient, it is important for you to have at least a little knowledge concerning what your Medicare Part D Formulary lists will cover of your prescription drugs. This will keep you informed of what kind of prescription drug coverage your Part D plan offers you. This will enable you to not be surprised or taken off guard by the cost of your prescription drug co-pay for any given prescription drug. You should always be aware of all aspect of your prescription drug coverage to better ensure that you are getting the best care drugs possible for you and your budget.
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John and Claire, Chicago IL