A formulary is a list of covered prescription drugs under a specific Medicare Part D Plan. The Centers for Medicare and Medicaid Services (CMS) require all prescription drug plans to:
Although there are certain requirements as prescribed by the CMS, the following types of common drug classes are typically excluded from Medicare Prescription drug plans (in certain cases, the drug will be covered if the drug is used to treat symptoms related to a specific disease):
The above Medicare excluded drug list is not exhaustive so if you are unsure of whether your prescription drugs are covered, you should contact your Medicare insurance plan provider or the CMS.
Drug plans are not standardized with respect to the number of drugs available. In a recent study conducted by Healthpocket, data showed that there are vast differences of covered drugs in 2014 Medicare Drug Plan formularies (ranging from 995 to 2333 covered drugs for Medicare Part D Plans). Even if a drug is included in a prescription drug plan’s formulary, there are often restrictions (quantity limits, prior authorization or step therapy).
As part of Medicare’s annual enrollment period, eligible consumers should confirm if their drug plan covers all of the drugs for the upcoming plan year and if there are any unreasonable restrictions in obtaining their prescriptions.
HealthPocket can help you by showing you all your choices for Medicare Part D plans and Medicare Advantage plans with prescription drug coverage. Our website allows you to provide information that will help personalize the cost for each plan. When you’ve selected the right Medicare plan, we will give you information so you can contact any carrier so you can fully understand the coverage and to make your purchase.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)