Q: What classes of drugs are not covered under Medicare Part D?
A: - Meds used for anorexia, weight loss, or weight gain
- Fertility drugs
- Medications used for cosmetic reasons (acne, bleaching, hair growth)
- Cough and cold medications
- Prescription vitamins and mineral products
- Over the counter medications
- Some specialty medications
- Barbiturates
- Some plans do not cover benzodiazepines
Q: How can I find out if a new medication is covered?
A: Unfortunately, the pharmacy cannot tell you if a new drug will be covered until they bill the claim. The only way to find out formulary information or which drugs are covered on your Medicare Part D plan is by contacting your insurance company. The number for each individual insurance company is on the back of your card.
Q: Why is my Medicare Part D copay different than last month?
A: There can be a variety of reasons that your Medicare Part D copay is different than the prior month. The most common reasons are a change in formulary or a change in your coverage. Medicare Part D plans can change formularies randomly, at any time. Medicare has 4 different sections of coverage. If you leave one section of coverage and go into a different section of coverage your copay can change drastically.
Q: I'm in my donut hole, how soon will it be until I'm able to have flat company's again?
A: Medicare Part D is broken up into 4 sections... your deductible, your initial coverage, your coverage gap, and your catastrophic coverage. This is how the four sections are broken down.
Deductible: The patient pays the first $325.00 dollars out of pocket.
Initial Coverage: The patient is responsible for company's until the total amount of payment has reached $2970.00.
Coverage Gap (donut hole): Begins once you reach your Medicare Part D plan’s initial coverage limit ($2,970 in 2013) and ends when you spend a total of $4,750 in 2013. During this time, the patient is responsible for 47.5% of the brand costs and 79% of their generic drug costs.
Catastrophic Coverage: After the patient reaches a total of $4750 of total drug costs, they enter the catastrophic coverage. During their catastrophic coverage, the patient pays $2.65 for generics and $6.60 for brand drugs.
Q: My doctor gave me a manufacture copay coupon for my expensive drug, can I use it to reduce my copay or to help me in the donut hole?
A: Unfortunately if you look at the back of the card there is some fine print that says if the patient is enrolled in any government funded healthcare, they cannot use the manufacture coupon. That government funded healthcare could be Medicare Part D, Medicaid, or Tricare.
No comments:
Post a Comment