Trumm Drug

Medicare Part D 2009 - What to Consider

Medicare Part D’s annual open enrollment period begins November 15th and runs through December 31st. During open enrollment, current Part D beneficiaries may choose to change plans and Medicare eligible patients without prescription drug coverage may enroll in a plan.

Part D plans change every year so it is important for current beneficiaries to review their current medication profiles against what their current plan will offer in 2009 as well as examine what other plans have to offer. Some things to consider when comparing plans include drug coverage, plan costs and the coverage gap.

Drug coverage is based upon a plan’s formulary or a list of drugs that the plan covers. Typical formularies include both brand and generic medications and include at least two drugs in each class of medications. Formularies may further divide medications into tiers such as generic, preferred brand and non-preferred brand with each tier having different copays. Some plans may also require a prior authorization for some medications, usually more expensive medications or medications that should only be used for a specific period of time. In the event a prior authorization is needed, your physician must contact the insurance company to explain why this particular medication is the best choice for you.

Plan costs will depend upon three factors and will vary from plan to plan. First, Part D plans have a premium or a monthly fee required to join the plan. Second, most plans will have a deductible or the amount you pay out of pocket before the plan starts to share your medication costs. While the maximum deductible for 2009 is $295 dollars, some plans may not have a deductible. Finally, a copay or coinsurance is what you pay when you have a prescription filled after you have met your deductible. A copay is a set amount depending on the tier into which the medication falls (generics usually have the lowest copay while non-preferred brands have the highest) whereas coinsurance is a percentage of the cost of the medication and will vary as medication costs vary. If costs are a concern to you, ask your doctor or pharmacist about generic medications that would be similar to the brand name medications you currently take.

Another cost related aspect of Medicare Part D plans is the coverage gap or “donut hole”. When you reach $2700 in total drug costs paid by both you and your plan you enter the coverage gap and are responsible for one hundred percent of your medication costs until you reach, at maximum, $4350 in total costs. Some plans offer coverage for generic medications while in the gap. Again, if the coverage gap concerns you, consult with your doctor or pharmacist to find ways to minimize your medication expenses.

The pharmacists at Trumm Drug are available to answer your questions and concerns about Medicare Part D coverage for 2009.

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