Medicare Part D is a federal health program designed to subsidize the
expensive costs of prescription drugs for people on Medicare in the
United States. Part D of Medicare went into effect on January 1st, 2006.
People can be covered for prescription drug purchases under plans
related to Medicare Part D if they are already entitled to benefits from
Medical Part A or have existing enrollment in Medicare Part B.
To obtain the drug benefit of Medicare Part D, a beneficiary can sign up
from one of two types of private plans: the individual can join a PDP,
or a prescription drug plan, that provides drug coverage, or the person
can join an MA or medicare advantage plan that provides coverage for
both prescription drugs and medical services (this is known as an MA
PD). Statistics indicate two thirds of people who benefit from Medicare
Part D choose the PDP option. Different drugs may have different levels
of coverage, which means participants are often led to choose particular
drugs over others. Tiered formulations are typically used which allot
less expensive drugs to lower tiers, making them cheaper to purchase and
easier to prescribe.
People who are dual eligible s are people who are also eligible for
benefits from Medicaid. These people were switched from having their
prescription drug coverage come from Medicaid to having it come from a
plan on Medicare Part D in 2006. These people now have a cheaper PDP
plan in their area that was randomly chosen. The majority of people who
can benefit from Medicare must actively enroll in a Medicare Part D plan
to receive its benefits. 27 million people are currently enrolled in
Medicare Part D.
It is important to note that there are several classes of drugs that are
not covered by Medicare Part D. The Food and Drug Administration is the
government agency assigned with declaring drugs safe for use in the
United States. Until a drug has been approved by the Food and Drug
Administration, it will not be covered by Medicare Part D. Similarly,
drugs that are prescribed for use off label and drugs that are not
available to be prescribed for buying in the U.S. are not covered under
Medicare Part D. If a drug can be paid for through either Parts A or B
of Medicare, it will not be covered under Part D. Additionally, drugs
used for weight loss, weight gain, or anorexia may be excluded from
coverage, as may drugs used to treat erectile dysfunction or promote
fertility.
Drugs prescribed for cosmetic purposes such as hair growth or hair
removal may not be covered. Drugs used to relieve people of symptoms
from coughs and colds may not be covered. Barbiturates, benzos, and
various prescription vitamins and minerals may not be covered. However,
many of these drugs may be included as supplemental benefits under drug
plans as long as they would otherwise be covered by the definitions of
Medicare Part D drugs. However, if you have a plan that covers one of
the excluded drugs described above, the plan will not be able to pass
the charges forward to Medicare. If plans are discovered to have billed
Medicare to cover such drugs, they will be required to pay CMS back.
