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Medicare Part D Made Simple

October 16, 2018
by Scott Langdon, RPh

There are two types of Medicare plans that cover prescription medications:
1. PDP plans
2. MAPD plans
PDP stands for Prescription Drug Plan
MAPD stands for Medicare Advantage Prescription Drug Program.

The difference between these plans is that one covers prescription drugs only (PDP) and the other is a health plan that covers prescription drugs (MAPD). In some instances a MAPD might be an affordable alternative to a medicare supplement.  Another difference is that the availability of PDP plans available to you is dependent on the State you live in.  MAPD plans are dependent on the county where you reside.

PDP– Prescription Drug Plan. A stand alone plan that only covers prescription drugs.
In 2019 there will be 27 PDP plans available in Florida.  This is up from last year’s total of 20 plans.  So if you are unhappy with your current plan it’s refreshing to know that 2019 brings in even more choices.

MAPD– Medicare Advantage Prescription Drug Program. A plan that is a health and drug plan rolled up into one.  In 2019 there will be 36 regular MAPD plans in our region. (Pinellas county)  That’s 12 more plans than last year’s total of 24.  If you qualify for a special needs plan (SNP), then there are 33 of those available in our county for a grand total of 69 plans.

Three important things to consider when choosing a Medicare Part D plan:

1. Preferred and non preferred networks.
Some plans have a preferred and a non preferred network. You could pay a higher price for your drugs at a pharmacy in the non preferred network. The exception would be persons who get special help (LIS). These members will pay the same as long as their pharmacy participates in the network regardless of whether the pharmacy is preferred or not. For plans with one network you will pay the same copay at any pharmacy as long as the pharmacy participates in the plan.
2. Drug Copays
Every plan has a formulary of covered drugs. Certain drugs may also have quantity limits. Most formularies are divided into 5 tiers. Some plans have 4 tiers. Lower tiers have lower copays. A good way to remember this is the higher the tier the more tears you will cry because your drug is more expensive. You will want to choose a plan that covers all your drugs and covers them in the lowest tier possible.
3. Deductibles.
Some plans have deductibles. This means you pay X amount of money out of pocket before your coverage kicks in. Some plans exempt Tier 1 drugs or Tier 1 and Tier 2 drugs from their deductibles. You may notice that often plans with lower premiums are the ones with deductibles. You must weigh out whether it’s worth paying a high monthly premium to avoid a deductible. If you’re on mainly lower tier medications it may be better to take a lower premium plan. Conversely, if you’re on a lot of high tier meds a PDP with a higher premium may work out better in the long run.
Scott Langdon, RPh


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