Medicare Part D Formulary And Drug List

Published: Wednesday, October 10 2018
Last Updated: a month ago

The Medicare Part D formulary tiers are unique because they help you learn all the drugs that are covered. Medicare formulary tiers have the most common and least expensive drugs at the bottom, and the tiers rise with the price of the drugs. There are a lot of people who must read the Medicare Part D drug list, and they will find that the drug list has many different medications. You should check the coverage when you are prescribed, or your doctor's office will let you know what they can cover.

What Is Medicare Part D Formulary?

Medicare Part D formulary is very interesting because it has a very long list of drugs that cover everything you have heard of and many other things you have not. The list is very long, and it is wise to check the list if you are looking for generic or name brand products. You might prefer to use the list when looking for treatment, or you could look over the list with your doctor.

What Are The Medicare Formulary Tiers?

The Medicare Part D drug list is very easy to read, and you can check it out online at any time. The list was created so that you as a covered person could figure out what you can get. There are a lot of other people who are going to read this list because they are trying to learn if their expensive or long-term medications are on there. You might need to know if a long-term medication is covered because you will be on it every day. Also, you could check for the generics that bring you back to tier 1 so that you can save money.

Tier 1

The Medicare formulary tiers start with 1, and you can get most of your common drugs from this tier. These are cheap drugs that are covered completely, and they are common things that people are put on every day. You have probably heard of many of the drugs on tier 1, and you could use tier 1 <a href="https://www.medicare.gov/sites/default/files/2018-07/11109-your-guide-to-medicare-prescrip-drug-cov.pdf">list</a> to figure out how many generics you can get so that you do not need to move up to tier 2.

Tier 2

The Medicare Part D drug list moves up to tier 2 to pay for most of the name brands that are a step up from generics on the tier 1 list. You might go into tier 2 because you need a particular drug, and you could ask your doctor's office if they can get you coverage on tier 2. Tier 2 is covered in a different way when you are on Medicare, and you must know how much coverage you will get for these medications. Checking the tier 2 list can be helpful to you if you have been told that the name brands will be most helpful to you.

Tier 3

The tier 3 list includes more expensive drugs that include long-term medications you use for many years because you are required to be on these medications for long periods of time. Medicare pays for these drugs that are often given every day or given through an IV, and they are listed on tier 3 just like the traditional medications. However, tier 3 is much smaller, and the drugs on this list are much more expensive than the others.

Tier 4

Tier 4 includes many new drugs that are very expensive, and there are many people who move up to tier 4 because they have no choice. You should talk to the doctor's office about how much coverage you can get because these drugs are not all covered the same way. Someone who is trying to change their health status might need to move up to these drugs, but they are so expensive that they are covered differently.

Tier 5

There are a few drugs on tier 5 that are very expensive, often only dispensed in hospitals, and have their own level of coverage. There are a lot of people who will find that they can get some coverage for the expensive drugs they need when they get admitted to the hospital, and the hospital often takes you through your options based on the coverage you have.

Considerations When Choosing A Medicare Formulary Tier

The Medicare formulary tiers are an important part of your overall health. You cannot keep yourself healthy and safe if you have not invested in the Medicare plan that will give you enough coverage based on the tiers where your drugs are found. You must have a look at the list to see if you can get the generics that you need, and you also should look over the list if you are trying to get a long-term medication that you believe is most necessary. These medications are easy to find, easy to cover, and have their coverage levels laid out clearly.