No matter where you get your prescription drug coverage, you need to be aware of your plan’s prescription drug formulary. The formulary is a detailed list of drugs that are covered by your plan. If you aren’t familiar with the formulary you may be surprised at the amount of copays that you are responsible for when it comes time to pick up your drugs. Here is how prescription drug formularies work.
The Tiers of a Formulary
Both Medicare Part D and Medicare Part C have a very specific list of drugs that they will cover and how they will cover them. This is where the tiers come in. The type of drug, who manufactures it and the need for a prescription of it will all fit into one of the categories of coverage. As you proceed down the tiers the money required by the patient in the form of a copay increases.
Generally tiers are broken down into these specific categories:
- Commonly used generic drugs that require the lowest of copays
- Less commonly prescribed or higher quality generic drugs with the next lowest copay
- Brand name drugs that are manufactured by a preferred vendor with a mid-level copay
- Brand name drugs from non-preferred vendors which are the highest copay
- Specialty drugs which may require additional insurance or special pricing plans
For any legal issues with prescription drug coverage or Medicare part C or D benefits, contact the experts at Stano Law Group today!