Are My Medications Still Covered By My Prescription Drug Plan (PDP)

That’s a very important question, especially during annual enrollment!

The best way to find out if your medications are covered by a Prescription Drug Plan (PDP), which is Medicare Part D, is to check the plan’s formulary (also called a “drug list”).¹

Here are a few ways you can check:

• Use the Official Medicare Plan Finder: The official government website’s Medicare plan comparison tool allows you to enter your drugs and dosage to compare costs and coverage across different plans in your area.
• Check the Plan’s Formulary: Each Part D plan has its own unique formulary.² You can:
  • Look for a “Drug List” or “Formulary” link on the insurance company’s Medicare website (e.g., Aetna, Humana, or WellCare).³
  • Look for a “Drug Search Tool” on the plan’s website to search for specific medications.⁴
  • If you’re already a member, sign in to your secure member portal to access the most current drug list and often estimate costs.⁵
• Contact the Plan Directly: You can call the plan’s customer service number, which is often found on their website or on any plan materials you have, and ask a representative if your specific medications are covered.⁶

Important things to look for when checking the formulary:

• Drug Tiers: Most plans divide their covered drugs into tiers (e.g., Tier 1, Tier 2, etc.). Drugs in lower tiers generally have lower copayments.⁷
• Requirements/Limits: Even if a drug is covered, there might be restrictions like:
  • Prior Authorization (PA): Your doctor needs approval from the plan before you can get the drug.⁸
  • Step Therapy (ST): You must try a lower-cost drug first before the plan will cover the prescribed drug.⁹
  • Quantity Limit (QL): The amount of the drug you can get at one time is limited.¹⁰