Frequently Asked Questions about Understanding Your Formulary

Nov, 09 2021 — Yes.  Some Medicare Part D prescription drug plans cover, not only brand-name and generic prescription drugs, but also so-called "Bonus Drugs" not usually covered by the Medicare Part D program, . . .

Jul, 04 2022 — Utilization management restrictions (or "usage management" or "drug restrictions") are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs a . . .

Jul, 04 2022 — Step Therapy is a utilization management restriction that your Medicare Part D prescription drug plan can add to a formulary medication. If you have a formulary drug subject to Step Therapy, you ar . . .

Nov, 14 2021 — Although Ambien, was covered by many Medicare Part D carriers in prior years, it is currently covered by only a few Medicare Advantage plans (MAPD) and no prescription drug plans (PDP). Instead . . .

Jul, 04 2022 — Some medications are carefully monitored by Medicare Part D plans to ensure your safety and your plan may require that you receive prior approval or "prior authorization" before your prescription will . . .

Mar, 13 2022 — Drug Tiers are an attempt to "logically" group drugs (such as generics, preferred-generics, brand drugs, and specialty drugs) within a list (drug formulary). All of your Medicare Part D prescriptio . . .

Aug, 09 2019 — Some abbreviations on your Medicare Part D plan's formulary are for Usage Management Restrictions or to further clarify the coverage details under your particular Medicare Part D prescription drug pla . . .

Aug, 24 2021 — A National Drug Code (NDC) is a number that uniquely identifies your prescription medication, the drug manufacturer, the medication strength, and the packaging of your medication. An NDC can be up . . .

Jul, 03 2022 — Quantity Limits (QL) are a Medicare Part D plan drug utilization management tool limiting the amount of a particular drug that the Medicare Part D plan will cover during a specified time period, such . . .

Aug, 02 2022 — We include the size of all Medicare Part D prescription drug plan formularies in our stand-alone Medicare Part D Plan Finder (PDP-Finder.com) and our Medicare Advantage Plan Finder (MA-Finder.com). . . .

Nov, 26 2021 — If your pharmacist tells you that one of your Medicare Part D prescription drugs requires prior authorization (PA), you should contact your Medicare Part D plan to find out about the PA requirement an . . .

Aug, 03 2021 — Medicare Part D prescription drug plans can change their plan formulary or drug list throughout the plan year - and you may find that new Part D drugs are added - or dropped - or formulary drugs may h . . .

Jun, 20 2016 — If you have a prescription for a drug that isn't on your plan's formulary, you should ask your doctor if there is another drug you can take that is on your plan's formulary.  If your doctor can't . . .

Jan, 10 2018 — This is known as a quantity limit restriction (such as 30 / 30 days or 30 pills for 30 days).  You can review your Medicare Part D plan's formulary for any Usage Management Restrictions or to f . . .

Dec, 01 2019 — A Coverage Determination is any decision made by a Medicare Part D plan regarding payment or coverage benefits to which a Medicare plan enrollee believes he or she is entitled. More specifically, . . .

Jan, 27 2022 — Yes.  We have our Formulary Browser online that includes every Medicare Part D prescription drug plan (PDP) and Medicare Advantage plan (MAPD) formulary or drug list - and all plan formularies ar . . .

Feb, 16 2021 — To learn more about low-cost insulin coverage, you can:Contact the Medicare drug plan's Member Services Department,Review the drug plan's Evidence of Coverage document,Speak with a Medicare representa . . .

Aug, 24 2021 — It depends on the type of formulary change.(1) No notice of a formulary change when replacing a brand-name drug with a new generic.Your Medicare drug plan (stand-alone Medicare Part D plan or Medicare . . .

Aug, 03 2021 — You and/or your prescriber can use our online Formulary Browser (https://FormularyBrowser.com) to check your Medicare Part D (PDP) or Medicare Advantage (MAPD) plan's drug list (formulary) for lower-c . . .

Aug, 10 2021 — No. The 75% Donut Hole discount, does not apply to Medicare Part D excluded drugs even if they are covered by the Medicare Part D prescription drug plan as a “Bonus Drug” (also known as &# . . .

Jul, 04 2022 — Utilization management restrictions (or "usage management" or "drug restrictions") are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs a . . .

Jun, 03 2022 — Some Medicare drug plans will mail printed abridged or shortened versions of the plan's complete drug list showing only a portion of the plan's covered prescriptions. Our Q1Medicare Formulary Browser will show all drugs covered by the plan along with additional coverage info.

Jan, 27 2022 — Yes.  We have our Formulary Browser online that includes every Medicare Part D prescription drug plan (PDP) and Medicare Advantage plan (MAPD) formulary or drug list - and all plan formularies ar . . .

Feb, 16 2021 — To learn more about low-cost insulin coverage, you can:Contact the Medicare drug plan's Member Services Department,Review the drug plan's Evidence of Coverage document,Speak with a Medicare representa . . .

Dec, 01 2021 — Indication-based utilization management (or indication limitations) is a type of utilization management that a Medicare Part D prescription drug plan can implement along with the plan's prior authoriz . . .

Jun, 05 2018 — Multi-source drug is a term used by the Centers for Medicare and Medicaid Services (CMS or Medicare) distinguish between: Generic / Preferred Multi-Source Drug and Other Drugs . . .

Aug, 03 2021 — You and/or your prescriber can use our online Formulary Browser (https://FormularyBrowser.com) to check your Medicare Part D (PDP) or Medicare Advantage (MAPD) plan's drug list (formulary) for lower-c . . .

Jul, 03 2022 — Quantity Limits (QL) are a Medicare Part D plan drug utilization management tool limiting the amount of a particular drug that the Medicare Part D plan will cover during a specified time period, such . . .

Aug, 10 2021 — No.  Only Medicare Part D prescription drugs found on your formulary receive the brand-name or generic 75% Donut Hole discount. Non-formulary medications, over-the-counter (OTC) drugs, and med . . .

Jan, 29 2017 — Medicare Part D plans can change formulary or drug list designs each year and with the new plan year, your Medicare prescription drug plan may have implemented utilization management (or drug usage ma . . .

Aug, 02 2022 — We include the size of all Medicare Part D prescription drug plan formularies in our stand-alone Medicare Part D Plan Finder (PDP-Finder.com) and our Medicare Advantage Plan Finder (MA-Finder.com). . . .

Nov, 14 2021 — Although Ambien, was covered by many Medicare Part D carriers in prior years, it is currently covered by only a few Medicare Advantage plans (MAPD) and no prescription drug plans (PDP). Instead . . .

Aug, 09 2019 — You may be paying full retail cost for your generic medications for a few reasons: You could be in the deductible phase of your Medicare Part D coverage and you are responsible for 100% of you . . .

Aug, 03 2021 — Medicare Part D prescription drug plans can change their plan formulary or drug list throughout the plan year - and you may find that new Part D drugs are added - or dropped - or formulary drugs may h . . .

Jan, 10 2018 — This is known as a quantity limit restriction (such as 30 / 30 days or 30 pills for 30 days).  You can review your Medicare Part D plan's formulary for any Usage Management Restrictions or to f . . .

Jul, 07 2019 — Co-Payment or Co-Pay is a type of cost-sharing that refers to a fixed dollar amount you pay for a medication assigned to a logical grouping or Tier of medications. Medicare Part D plans group the . . .

May, 15 2015 — Co-Insurance is a type of cost-sharing that refers to the payment of a percentage of the medication's negotiated retail drug cost that you would pay for a medication assigned to a logical grouping or . . .

Jul, 26 2019 — As noted by the United States Food and Drug Administration (FDA): "The term “authorized generic” drug is most commonly used to describe an approved, brand name drug that is marketed a . . .

Aug, 09 2019 — Some abbreviations on your Medicare Part D plan's formulary are for Usage Management Restrictions or to further clarify the coverage details under your particular Medicare Part D prescription drug pla . . .

Aug, 24 2021 — It depends on the type of formulary change.(1) No notice of a formulary change when replacing a brand-name drug with a new generic.Your Medicare drug plan (stand-alone Medicare Part D plan or Medicare . . .