Medicare Part D prescription drug plans (
PDPs and MAPDs)
change every year and no matter whether
you joined a new plan or stayed with your same plan from 2019, there are
a number of possible reasons why you may be paying more for your
prescriptions in 2020 – and a few suggestions about
controlling costs.
- Your medication is no longer covered by your 2020 drug plan.
If your 2020 prescription drug plan
dropped your medication from the plan’s formulary – possibly due to the
availability of a less-expensive generic drug – your plan will provide
you with a 30-day transition fill so you have time to find an alternative medication or file a
formulary exception request asking for coverage of your non-formulary drug.
Transition fills are not free and
the cost of your transition fill
can be more than what you paid for your medication last year. In
addition, if you have not requested a transition fill, or already used
your 30-day
transition fill, you will pay the full retail cost for your non-formulary medication.
Suggestions: (1) Request a transition fill, (2)
search for a generic or alternative formulary medication, (3) request a
formulary exception for coverage of a non-formulary drug (
click here to learn about requesting a formulary exception), (4) if you are enrolled in a Medicare Advantage plan (MA or
MAPD),
you can use the Medicare Advantage Open Enrollment Period (
MA-OEP)
to switch to a plan (
PDP or MAPD)
that covers your drugs (the MA-OEP runs through March 31st), and (5) check the drug price using a
drug discount program.
Reminder: You can ask your plan to cover a non-formulary drug or ask your plan to move a formulary drug to a lower costing tier, but
you cannot ask
your plan to cover a non-formulary drug and then ask for a tiering exception to lower the cost of the drug.
- You are still in your plan’s Initial Deductible.
Your 2020 Medicare prescription drug plan may have a higher Initial Deductible than last year (as reference, the
2020 standard deductible is $435).
So you may be paying full price for your medications, until you meet
your 2020 plan’s deductible. For example, if you were enrolled in the
2019 Texas
SilverScript Choice (PDP)
that had a $100 deductible, your 2020 Initial Deductible is now $360,
so you will be in your Initial Deductible longer this year. You can
click here to read more about 2019 plans that increased their Initial Deductible in 2020.
Suggestion:
Be prepared to pay full retail cost until you meet your plan’s
deductible or, depending on your plan, seek generic drugs that may be on
a lower-costing formulary drug tier (such as Tier 1) that is
excluded from your plan’s deductible.