Coverage Rules- Medicare Part D

I’d like to talk about the coverage rules that apply to Medicare Prescription Drug Coverage Plans. The three main rules are prior authorization, step therapy, and quantity limits which were made to ensure that drugs are being used for the purpose they are specifically made for and only when your medical condition deems it necessary to take. The first rule, prior authorization, is when before you are able to be prescribed a drug, your prescriber has to contact your Medicare plan and make sure that you have a medical condition that requires you to take that particular prescription drug. Step therapy, another rule, is actually a type of prior authorization. It a process that requires you to first try less expensive or generic drugs that have been proven effective for the majority of people with your medical condition before your can try a more expensive or brand name drug. However, you can avoid this process if you have previously tried the less expensive or generic drug with another plan and if your physician believes that only the brand-name or more expensive drug will work for your medical condition. Quantity limits are made to ensure the safety of the patient if the prescription drug can be addictive, deadly, harmful for other parts of your body, and various other safety reasons. They are also made to help control costs if you only need to take the prescription drug every few weeks or months.

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

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