Part D Plans
What Medicare Part D drug plans cover:
All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDS. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Many plans place drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.
To lower costs, many plans offering prescription drug coverage place drugs into different “ tiers” on their formularies. Each plan can divide its tiers in different ways. Each tier costs a different amount. Generally, a drug in a lower tier will cost you less than a drug in a higher tier.
Here's an example of a Medicare drug plan's tiers (your plan’s tiers may be different):
Tier 1 lowest co-payment: most generic prescription drugsTier 2 medium co-payment: preferred, brand-name prescription drugs
Tier 3 higher co-payment: non-preferred, brand-name prescription drugs
Tier 4 High Cost Prescriptions
Tier 5 Very high cost prescription drugs
In some cases, if your drug is in a higher tier and your prescriber (your doctor or other health care provider who’s legally allowed to write prescriptions) thinks you need that drug instead of a similar drug in a lower tier, you or your prescriber can ask your plan for an exception to get a lower coinsurance or co-payment for the drug in the higher tier. Plans can change their formularies at any time. Your plan may notify you of any formulary changes that affect the drugs you’re taking.
Medicare drug coverage includes drugs for medication-assisted treatment for opioid use disorders. It also covers drugs like methadone and buprenorphine when prescribed for pain. However, Medicare Part A covers methadone when used to treat an opioid use disorder as an inpatient in a hospital, and Part B now covers methadone when you receive it through an opioid treatment program. Contact the plan for its current formulary, or visit the plan’s website.