After you have made a Part D drug plan choice, remember that things could change that may affect the coverage and cost of your drugs. Here is a checklist of things that you should watch for:

Formularies can change

Drugs may be added to or taken off a plan formulary. Most drug plans will have a formulary, which is a list of all the drugs covered by the plan, including brand name drugs and their generic versions if they are available. Most changes to a plan's formulary list will take place at the beginning of a calendar year; drug plans may add or drop coverage of certain drugs during the year. If a plan removes a drug from the formulary, it must let you know about the change at least 60 days before it takes place.

Plans are likely to make changes to their formularies as new drugs are approved or if a drug is found to be unsafe. If a drug is found to be unsafe, the plan must let you know, in writing, why the drug is being removed from the formulary and give you a list of other drugs that could be used in its place. Plans are not required to let you know when they add new drugs to the formulary.

Some drugs cannot be covered under Part D

Although most FDA-approved prescription drugs may be covered by Part D drug plans, certain types of drugs cannot be covered. These are listed below:

• drugs used for loss of appetite, weight loss, or weight gain
• drugs used to promote fertility
• drugs used for cosmetic purposes or hair growth
• drugs used to relieve cough and cold symptoms
• prescription vitamins and minerals, except prenatal vitamins and fluoride preparations
• non-prescription drugs
• outpatient drugs for which the maker of the drug requires certain tests or monitoring services that must be purchased only from them or a designee as a condition of sale
• barbiturates and benzodiazepines (certain drugs to help people sleep or calm them down)

If you are eligible for both Medicare and Medicaid, your state Medicaid program may help you pay for some of these drugs if they are medically necessary.

Drug prices are likely to change

A drug plan's monthly premium is fixed for the calendar year and may not be changed. But, the beneficiary's cost for a drug from a plan pharmacy or from a mail service may change if a plan changes the status of a drug from preferred to non-preferred or drops coverage altogether. If such a change results in an increase in your out-of-pocket costs, the plan must notify you in writing 60 days before the change takes place.

Also, if the price of a drug changes over the course of a year, the amount you pay out-of-pocket may change, too. So, if the cost of a drug goes up during the year, your cost for the drug could go up if you are paying the entire cost of the drug – for example, in the deductible period or in the "donut hole" when you have no coverage. You can watch for these price changes on the Medicare Web site (www.medicare.gov) or by calling 1-800-MEDICARE (1-800 633-4227) toll-free, or by visiting your drug plan's Web site or calling their customer service toll-free line.

Participating pharmacies may change

As noted before, all Medicare Part D plans must have a network of pharmacies that take part in their plan throughout the area they serve. These networks must give beneficiaries convenient access, taking into account the distance and travel time to the nearest plan pharmacy. The agreements between pharmacies and Part D plans are generally for at least a 1-year period. But, pharmacies may choose to drop out of a plan's network at any time.

You can watch for changes in a plan's pharmacy network by visiting the plan Web site or asking for a pharmacy directory from the plan's toll-free customer service line.

Last Medical Review: 10/23/2008
Last Revised: 10/23/2008