MEDICARE.GOV DRUG PLAN FINDER TOOL

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1 MEDICARE.GOV DRUG PLAN FINDER TOOL Part 1 Part 2 A General Search is adequate for most people --The only required entry is your zip code Page 1 of 12

2 Part 3 Check the appropriate box under each section and press Continue to Plan Results Page 2 of 12

3 Part 4 Important: See notes below A B C A. If you don t take any drugs select I don t take any drugs. The only costs shown will be for the plan premiums. If you select I don t want to add any drugs now the results will assume you take drugs and will be based on an estimated amount for the average Medicare beneficiary. B. If you have not previously saved your Drug List, begin by entering each medication you take regularly. Have all your prescriptions in front of you. You will be asked the dose, quantity and frequency of your medication as you enter each drug. C. If you have previously saved your Drug List, enter the Drug List ID and your Password Date now. Page 3 of 12

4 See notes below Part 5 If you enter a brand drug that may have a generic form available, you will be asked to choose whether to keep the brand or change your search to the generic alternative. For each drug you will also be asked whether you get it from a retail pharmacy or mail order. If you get 90 day refills be sure to adjust the quantity and frequency accordingly. Part 6 Your Drug List ID has now been assigned. PRINT OR WRITE THIS NUMBER DOWN ALONG WITH THE PASSWORD. Although the brand Cozaar was selected instead of the generic, the Drug List provides the name of the generic. Use this information to discuss your options with your health care provider to lower your costs. Page 4 of 12

5 See notes below Part 7 B A A. For this Part, choose a pharmacy. If you don t, one will be randomly selected and not identified. It may not reflect what you will actually pay at your pharmacy. B. You can select two pharmacies, and you can change the number of miles around your ZIP code to include more pharmacies. Most Drug Plans provide benefits at nearly all pharmacies. However, each pharmacy may charge more or less than another pharmacy for the same drug. Some drug plans have Preferred Pharmacies with significantly lower costs. The Network and Preferred pharmacies will be indicated on the detailed results for each specific plan. Page 5 of 12

6 Part 8 See notes below Under the heading Summary of Your Search Results, if you use Original Medicare select Prescription Drug Plans (with Original Medicare). If you want to confirm that your desired Medicare Advantage Plan covers your drugs, select the second category Medicare Health Plans with drug coverage. The tabs at the far left of the page allow you to refine your search. Generally it is not necessary to use these tabs, since so much information is included in the basic plan results. Further, by limiting your choices you could inadvertently eliminate a plan you might wish to consider. If you do want one of the Special Needs Plans to be included in the results, refine your search for that feature and say Update Plan Results. Any available plans will be included with the Medicare Health Plans with Drug Coverage results. Page 6 of 12

7 See notes below Part 9 The page above shows all the prescription drug plans in your designated zip code, sorted by the lowest estimated annual cost. If you specified your current plan in the initial part of the search, that plan will be shown first regardless of its cost. The drug cost under Original Medicare (with no drug plan) will always be shown next. Following that will be the plans ranked in order of lowest annual cost or whatever other sort criteria you specified. Page 7 of 12

8 Column One: The check boxes allow you to compare up to three plans side by side. Check the box of the plans you wish to compare and then click on the orange Compare Plans button at the top or bottom of the page. The Estimated Annual Drug Costs for the plan shows you the total annual cost of all monthly premiums, deductibles, copays, and cost of drugs not covered during the Gap. If it s midway through the year, then this number will be prorated for the rest of the year. Note that in some cases plans with higher premiums or that have deductibles could cost you less over the course of the year. Column Two: This is the cost of your monthly premium. Column Three: Drug plans can have an annual deductible that can range from zero to $310. The deductible represents the amount you will pay before your Drug Plan begins paying benefits. Column Four: Drug restrictions can occur for three reasons: Quantity Limits; Prior Authorization; or Step Therapy. In Quantity Limits, plans may limit the quantity of drugs that they cover over a certain period of time. Prior Authorization will require that you work with your doctor and the plan to get an exception. Step Therapy means you will be required to try a different medication first. You can click on the blue link next to the restriction to find out more. This column also answers three questions you may have. First and most important, are all your drugs available on the Plan s Formulary? Second, are there any restrictions? Third, can you lower the cost of the drugs? Click on the link Lower Your Drug Costs to discover what changes would lower your cost. Also it indicates if the plan participates in the Medication Therapy Management program which gives you access to a pharmacist to insure the most effective use of your drugs. Column Five: Medicare has gathered the opinions of Medicare recipients and other data regarding the customer service of each plan. This information can be useful. On a later screen you can find out all the criteria and the specific ratings for each of the criteria for a given plan. Column Six: Finally, and conveniently, you can enroll online. Be certain to print each page before going to the next. You will have no record of registration without a printed copy. Page 8 of 12

9 Part 10 This screen shows the beginning of the side-by-side comparison of three plans. The plans are shown in random order. The comparison includes the prorated annual costs at your selected pharmacies and by mail order, the costs for each drug, possible drug restrictions, when you might hit the coverage gap (donut hole), and plan ratings. For even more detail about a plan s coverage, click on the individual plan name. Page 9 of 12

10 Part 11 When you click on the name of one drug plan an expanded and detailed view of the plan is available for review. Following is the first of three views of the same page for a single plan. For some plans Mail Order is available with a significant cost savings. Not all Mail Order plans will save money. Page 10 of 12

11 View two of the same page. Here you can switch between the cost of purchasing your drugs directly from one of the pharmacies, or using Mail Order to determine which is most practical and cost effective. Option #1 Option #3 Column One: Lists the drugs you entered into your Drug List and the dosage. Column Two: The average retail price of your drug. The amount you actually pay will be determined by the pharmacy you choose. This is the price you pay if your drug is not on the plan s formulary. Column Three: How often you refill your prescriptions. Column Four: This plan has an Annual Deductible; this is the price you pay until you have met your Deductible. Column Five: Here is where your benefits begin. You will share costs with the Drug Plan. This column shows what you will pay initially before you enter the Gap (or Donut Hole). You will pay this all year if you never enter the Gap. Column Six: If you enter the Coverage Gap, you will pay this amount, which in 2014 is 47.5% of the cost of brand name drugs and 72% of generic drugs. Column Seven: After you ve spent $ 4550 out of pocket for the year and exit the Donut Hole, you will pay this amount for catastrophic coverage for the remainder of the year. Below that chart is a graph showing the total monthly costs including the monthly premium as well as drug costs. Page 11 of 12

12 View three of the same page Prescription drug plans (PDPs) maintain a list of drugs they will pay for, called a formulary. The formulary is comprised of generic drugs, brand drugs, specialty drugs, and over-the-counter-drugs (OTC). Within the formulary there are groups of drugs that fall within description and pricing groups. Each PDP has its own formulary and Tier system. Tier 1: Generally preferred generic drugs, the lowest cost drugs that have the lowest co-pay. Tier 2: This tier often includes the more expensive generic drugs. Co-pays for this tier are higher than Tier 1. Tier 3: This tier generally includes the less expensive, preferred brand drugs. Co-pays for this tier is higher than Tiers 1 and 2. Tier 4: This tier typically includes the more expensive brand drugs. They are sometimes called non-preferred. The co-pay for this tier is higher than the preceding tiers. Tier 5: Newly approved brand drugs and specialty drugs such as those used for chemotherapy fall under this tier. Your copay will be a percentage of the retail price of the drug. Part 12 If you wish, click on the Plan Ratings tab to learn detailed information about how Medicare beneficiaries have rated the plan on various criteria. Page 12 of 12

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