Medicare Part D prescription drug plans change every year and no matter whether you joined a new plan or stayed with your same plan
from 2020, there are a number of possible reasons why you may be paying more for your prescriptions in 2021.
- Your medication is no longer covered by your 2021 drug plan.
If your 2021 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:
- Request a
transition fill,
- search
for a generic or alternative formulary
medication,
- request a formulary
exception for coverage of a
non-formulary drug (click
here to learn about requesting a formulary exception),
- 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
- 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 2021 Medicare prescription drug plan may have a higher Initial Deductible than last year (as reference, the
2021
standard deductible is $445). So, you may be paying full price for your
medications, until you meet your 2021 plan’s deductible. For example, if you were enrolled in the 2020
South Carolina
EnvisionRxPlus
(PDP) that had a $335 deductible, your 2021 Initial Deductible is now $445, so you will be in your
Initial Deductible longer this year. You can
click
here to read more
about 2020 plans that increased their Initial Deductible in 2021.
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.