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tiers are how Medicare organizes covered prescription drugs

What Are Medicare Part D Drug Tiers?

Medicare Part D provides prescription drug coverage. Some drugs are covered under Part B, but for those that are looking for more extensive coverage, Part D is the answer.

Who Needs Part D?

Medicare does not require Part D enrollment and it is completely up to the beneficiary whether or not they’ll utilize this coverage. Anyone who regularly takes prescription drugs should consider Part D, as prescriptions can be expensive and those taken routinely can quickly add up. If you’re noticing your pharmacy bills are increasing or you’re beginning a new medication, consider how Part D could lower your bills.

So What Are Drug Tiers?

Tiers are how Medicare organizes what drugs are covered and how much the copayment is. Each tier has an increasing copayment but also includes more drugs. When you’re considering which tier to select, look into what specific prescriptions it covers. Many people aim to select the tier that will cover the majority, if not all, of their prescriptions.

Tier 1 has the lowest of copayments and includes many generic drugs. Tier 2 has a medium copayment. Tier 2 includes the brand-name, preferred prescription drugs. Many people may choose Tier 2 because of its convenience and range of offerings. Tier 3 has a higher copayment than the lower tiers and also includes brand-name prescriptions, including those that are non-preferred.  

The specialty tier has the highest copayment, but it covers expensive prescription drugs. Some people may choose one of the lowest tiers even if they aren’t currently taking a drug that is covered. This can be done as a preventative measure. If you are taking a prescription drug, it’s best to select your coverage based on that.  

Can Drug Coverage Change?

Just like you might want to change your drug coverage, Medicare can make changes as well. Each year beneficiaries should see if there are any updates to their plan. New prescriptions are constantly being made, many of which are safer, more convenient, and reliable. In order to stay up to date on the pharmaceutical industry and its offerings, Medicare must make changes to their coverage.

These changes could include adding or removing medications or possibly a shift in what a tier offers. If a change has been made to your plan and you wish to change your coverage, it’s best to do so during the Annual Enrollment Period. This begins October 15th and ends December 7th. If you have questions about Part D enrollment, we’re here to provide you with answers. You can call us or send us an email and we’ll be in touch soon.