Prescription drug coverage
A simple guide to Part D.
Before we compare your medications against a plan, here's how prescription drug coverage works — in plain language.
What is a formulary?
A formulary is simply the list of prescription drugs a plan covers. Each Medicare Advantage plan with drug coverage (MAPD) or stand-alone Part D plan has its own formulary. If your medication isn't on the list, it may not be covered — or it may require approval first. That's why we always check your specific drugs before recommending a plan.
What are tiers?
Drugs on a formulary are grouped into tiers. The tier your medication falls under decides what you pay. Lower tiers generally cost you less.
Preferred generic — Lowest cost
Most generics; often your cheapest option.
Non-preferred generic — Low cost
Other generics that cost slightly more.
Preferred brand — Medium cost
Brand-name drugs the plan prefers.
Non-preferred brand — Higher cost
Brand-name drugs with higher copays.
Specialty — Highest cost
Specialty and high-cost medications.
Other terms to know
Copay vs. coinsurance: A copay is a fixed dollar amount (like $10). Coinsurance is a percentage of the drug's cost (like 20%). Most plans use copays for lower tiers.
Deductible: The amount you pay out of pocket before your plan's drug coverage kicks in. Some plans waive the deductible on lower tiers.
Preferred pharmacy: A pharmacy your plan partners with for lower copays. Using a preferred pharmacy can save you money each month.
Prior authorization: Some drugs require the plan's approval before they'll cover them. We'll help you understand if any of your medications need this.
Before you choose a plan, gather your medication list.
Bring a list of your prescriptions, doses, and preferred pharmacy. We'll check every plan against your exact medications — at no cost to you.