The parameters of a Medicare prescription drug benefit are changed each year by Medicare. In addition, whether you are on a stand-alone drug plan or have the drug benefit included in your Medicare Advantage/HMO plan, the insurance companies can also change the drug formulary (listing of drugs covered by the plan, along with the tier and cost of the drug for the upcoming year) from during the year. Also remember not all prescription drugs are covered by any one Medicare drug plan.
The drug formulary provided by your prescription drug plan carrier should always be with you when you go to see your doctors or if you are expecting a call from a doctor regarding a new medication. Whether you are on a Medicare stand-alone drug plan or Medicare Advantage/HMO carrier there is an alphabetical listing in the back of your drug formulary booklet to reference to see if the new prescription being recommended for you is on your current prescription drug formulary, and if so, at what tier and cost. Instead of waiting to find out when you go to the pharmacy whether your new prescription drug is covered and at what cost, your formulary will be able to tell you. If the suggested drug is not on your drug formulary for this year, or is but it’s on a higher tier and costly, ask your doctor if there is a lower cost alternative. If one is not available, then ask the doctor if s/he has any samples you can try for a few months before incurring the expense of buying the drug and then having an adverse reaction to the drug or finding out that there is no improvement in your condition.
The next opportunity you will have to change your prescription drug plan is during Medicare Annual Enrollment (October 15 thru December 7) when you can select a different drug plan based on your current drugs. Your selected plan would be effective January 1st of the upcoming year.