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medicare prescription drug coverage information

Standard Benefits for Medicare Part D Plans
Standard benefits for Medicare Part D plans include:
• Formulary
• Catastrophic Coverage
• Deductible
• Coverage Gap
Total Out-of-Pocket Drug Costs
The amount the consumer pays for prescription drugs starting January 1, not including premiums, but including the following:
• Deductible
• Copays/Coinsurance
• Coverage Gap Drug Costs
Note: Costs that are paid by the member, another person on behalf of the member, a qualified State Pharmaceutical Assistance Program (SPAP), a bona fide charity, and Drug
Manufacturers will count toward TrOOP. However, costs paid by employers or unions do NOT count toward TrOOP.
Definitions
Definition of Formulary:
A list of the drugs that are covered by the plan.
Definition of Abridged formulary:
A partial list of the commonly used covered drugs on the plan formulary.
A Formulary Exception Request:
Request for the plan to cover a medication that is not included in the formulary.

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