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Part D Prescription Drug Plans
Part D Prescription Drug Plans help to cover the cost of outpatient prescription drugs. These are stand alone plans with drug benefits only. Enrollment is voluntary, however coverage is required or penalties may be applied.
About PDP Plans
Each Part D Prescription Drug Plan has a formulary list of covered drugs. This can be found in the documentation of the plan. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes.
Part D plans are required to include a full range of drugs in six classes on their formularies. These classes include: Anticonvulsants, Antidepressants, Antineoplastics, Antipsychotics, Antiretrovirals, Immunosuppressants.
Each year, during the Annual Election Period of Oct 15 - Dec 7. Plans start on Jan 1 and end on Dec 31. If you have a qualifying life event, you may use a Special Enrollment Period to change your plan.
The Medicare Part D donut hole or coverage gap is the phase of Part D coverage after you and your drug plan have spent a certain amount for covered drugs. Once you reach the coverage gap, you'll pay no more than 25% of the cost for your plan's covered brand-name prescription drugs.
Medicare participants who get Extra Help paying Part D costs won’t enter the coverage gap.
Medicare participants who get Extra Help paying Part D costs won’t enter the coverage gap.
Cost for vaccines covered by Part D will depend on your specific plan. You may pay a copay or coinsurance for Vaccines Covered by Part D:
- Shingles vaccine: One-time vaccine given in two shots over two to six months - as of Jan 1, 2023 offered at $0 copay on Part D.
- Tdap vaccine (tetanus, diphtheria and pertussis/whooping cough): One shot if you’ve never been vaccinated, and a booster every ten years
- Other vaccines covered: Vaccines that are "reasonable and necessary" to prevent illness and are not covered by Part B
- Drugs used to treat anorexia, weight loss, or weight gain
Note: Part D may cover drugs used to treat physical wasting caused by AIDS, cancer, or other diseases - Fertility drugs
- Drugs used for cosmetic purposes or hair growth
Note: Drugs used for the treatment of psoriasis, acne, rosacea, or vitiligo are not considered cosmetic drugs and may be covered under Part D - Drugs that are only for the relief of cold or cough symptoms
- Drugs used to treat erectile dysfunction
- Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)
- Non-prescription drugs (over-the-counter drugs)
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