Prescription Plans

• Your Medications: Ensure the plan's formulary includes your current and expected potential prescriptions.
• ​Pharmacy Network: Does the plan include your preferred pharmacies?​
• Total Cost: Analyze premiums, deductibles, copays/coinsurance, and the likelihood of reaching the coverage gap to estimate the actual cost.​
• Restrictions: Some plans may have step therapy (trying less expensive drugs first) or prior authorization requirements.

• Formulary: A list of covered medications, often organized into tiers with different cost-sharing levels (e.g., generics vs. brand-name).​
• Deductible: You may need to pay this amount out-of-pocket before certain coverage kicks in.​
• Copayments: A fixed amount you pay for each prescription.​
• Coinsurance: A percentage of the drug's cost that you pay.​
• Coverage Gap (Donut Hole): (Mostly applies to Medicare Part D) A temporary period of higher out-of-pocket costs.

• Medicare Part D: Standalone plans that work alongside Original Medicare (Parts A and B) to cover prescriptions.​
• Medicare Advantage Plans (Part C): Most of these plans include prescription drug coverage (Part D) within the bundled plan. If you choose an Advantage plan that does not provide prescription drug coverage, you may enroll in a standalone Part D plan.
• ​Employer-Sponsored Coverage: Some employers include prescription coverage in their health insurance benefits.
• ​Individual Marketplace Plans: You might find plans with prescription coverage on the Health Insurance Marketplace.

Prescription drug costs can be significant. That's why prescription drug plans are an important part of many people's healthcare strategy.