Is there a limit on the number of drugs a plan will cover in a given year?
No. There is no limit on the amount of drugs that can be covered. However, each Medicare drug plan will have a list of the specific prescription drugs that it will cover (called a formulary), and not all plans will cover exactly the same drugs. If your doctor thinks you need a drug that is not on the plan’s list, you can ask the plan for an “exception” to its list. Plans may cover both generic and brand-name prescription drugs. These drugs must be approved by the FDA (Food and Drug Administration) as safe and effective.
Will some drugs still be covered under Part B?
Yes. Medicare Part B will still cover drugs that it covers now (like some cancer drugs) that are usually given out by a doctor in his or her office. Drugs that are not covered under Part A or Part B will, in most cases, be covered under Medicare prescription drug coverage.
What does a Medicare drug plan cover?
Medicare drug plans will cover generic and brand-name drugs. Plans may have rules about what drugs are covered in different drug categories to be sure people with different medical conditions can get the treatment they need.
Most plans will have a formulary, which is a list of drugs covered by the plan. This list must always meet Medicare’s requirements, but it can change when plans get new information. Your plan must let you know at least 60 days before a drug you use is removed from the list or if the costs are changing. In most cases, if you are actively taking a formulary medication, you will be able to continue on it for the full calendar year. If your doctor thinks you need a drug that isn’t on the list, or if one of your drugs is being removed from the list, you or your doctor can apply for an exception or appeal the decision.