Medicare Part D: Things People With Cancer May Want to Know

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Are you ready to get started?

Now that you have a better understanding of how the Medicare Part D prescription drug plan works, you may be ready to look at your options and make a decision. This list can help you be sure you’ve done all you can to choose the best plan for you.

  • Check the plan formularies to figure out which plans cover all or most of your drugs
  • Check how the formulary tiers affect what you have to pay
  • Compare the plan premiums and other cost-sharing requirements (such as deductibles, co-insurance, and co-pays)
  • Check for drug conditions or restrictions, such as limits, prior authorization, and step therapy requirements
  • Look into whether you qualify for Extra Help (the low-income subsidy)
  • Find out which of your cancer drugs are still covered under Part B
  • Understand how off-label drug uses are treated under Part D
  • Understand your appeal rights
  • Check to see which plans offer the best drug coverage (brand name or generic) in the coverage gap (donut hole)
  • Check with your doctor to see if you can use a generic drug instead of a brand name drug to reduce costs. Some plan formularies may cover the generic version of a drug, but not the brand name drug.

Last Medical Review: 01/22/2014
Last Revised: 01/23/2014