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A formulary is a list of prescription drugs covered by a plan.
Because Medicare Part D is provided by private insurance companies such as Aetna and SilverScript, each company can decide which drugs to cover. However, a formulary must meet the minimum standards and requirements of Medicare Part D coverage.
Medicare Part D formularies are approved by Medicare and updated throughout the plan year, and may change if:
Plans will let members know about any changes that may affect a drug they take.
Formularies are set up in tiers. A drug in a lower tier usually costs less than a drug in a higher tier. Use a plan’s formulary to tell you which drugs are covered and which tier they are in. The tiers are numbered and include:
Tier 1, Preferred Generic: These are commonly prescribed generic drugs.
Tier 2, Generic: These drugs are generic but usually cost more than the drugs in Tier 1.
Tier 3, Preferred Brand: These are brand-name drugs that don’t have generic versions. They are the lowest-cost brand-name drugs on the list.
Tier 4, Non-Preferred Drug: These are higher-priced brand-name and generic drugs, less commonly prescribed than drugs in the preferred tiers.
Tier 5, Specialty: These are the most expensive drugs on the list. They may require special handling and/or close monitoring.
See if your prescriptions are covered in our plans.
Federal law prohibits a Part D plan from covering certain types of drugs, including:
In addition, Medicare Part D plans are unable to cover the following:
For more information on formularies, drug tiers and prescriptions, please visit our Unpacking Medicare prescription drug coverage page.
Enter a zip code to find a Medicare plan near you.
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