What is a Medicare Part D Formulary?

Many people have heard of the term formulary, but might not know what it is and how it impacts your Part D benefits. Whether you are enrolling for the first time, or are currently receiving benefits under a Part D prescription plan, you will need to understand the importance of the term Medicare Part D formulary.  Failure to do so could ultimately cost you hundreds, or even thousands, of dollars.

So, what is a formulary?

 A formulary is a list of prescription drugs, both brand name and generic, covered by a Medicare Part D drug plan.  Each provider of Part D benefits has the freedom to select their formulary and will participate in the overall cost of the medications.  Should you take a medication that is not on a specific formulary, you would be responsible for 100% of the cost, or you would have switch to a comparable medication on their formulary to receive any financial benefits.

What is most important to understand is that formularies will vary among all the Part D providers in your area.  Therefore, when researching your options for a prescription plan, make sure your current medications are on the Medicare Part D formulary for the plan you chose.  Matching your medications to the various formularies can be accomplished on www.medicare.gov, or you can also contact us and we can provide an independent analysis of your medications and your options.

When should you research your medications and formularies?

  • If you are new to Medicare, make sure you perform this search or contact us within your Initial Enrollment Period (IEP), which is the 7-months that surround your 65th birthday.
  • If you are retiring after age 65, you have 60 days from your last day of health coverage to enroll in a Part D plan. Make sure you do not miss this enrollment window!
  • If you are a current Medicare beneficiary, you will have to wait until the Annual Enrollment Period (AEP) to make any changes to your current coverage.  AEP occurs every year from Oct 15 through Dec 7, and changes go in to effect on January 1 of the following year.  You should perform a Medicare Part D formulary search annually even if you have been on the same plan for years.  Drugs can be added and removed from a formulary with some frequency, so assuming your medications are covered every year might ultimately be an incorrect and costly assumption.
  • If you are eligible for a Special Enrollment Period (SEP), you will want to evaluate your Part D benefits and formulary comparisons during your eligibility period.
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