We see frequent changes in health insurance plans every year, especially Medicare Part D coverage. Every year, Medicare adjusts the list of prescription drugs, healthcare products, and services they will pay. This revised list is released several months in advance to give Medicare Part D recipients, health care providers, and caregivers time to adjust.
We now know what drugs are covered by Medicare Part D and what medications will not be covered in the coming months for 2023. In this article, we will discuss some of the most significant changes that you should know about.
Highlights from the Medicare Part D Drug List for 2023
Medicare.gov released the new details for the changes. These details include information on new deductible amounts and coverage limits, brand-name and generic prescription drug discounts, increased out-of-pocket costs, and how these changes for 2023 will affect your coverage.
New Medicare Part D Deductible Amounts and Coverage Limits
Plans offering Medicare drug coverage under Part D may remove drugs from their formularies after the Food and Drug Administration (FDA) considers them unsafe or if their manufacturer removes them from the market. Plans meeting certain requirements can also remove brand name drugs from their formularies and replace them with new generic drugs, or they can change the cost or coverage rules for brand name drugs when adding new generic drugs.
If you’re currently taking any of these drugs, you’ll get information about the specific changes made afterwards.
For other changes involving a drug you’re currently taking that will affect you during the year, your plan must:
- Give you written notice at least 30 days before the change becomes effective, OR
- At the time you request a refill, provide written notice of the change and at least a month’s supply of your medication.
The Cost of Generic Drugs for Medicare Recipients in 2023
The Food and Drug Administration (FDA) says generic drugs are copies of brand-name drugs and are the same as those brand-name drugs in:
- dosage form
- route of administration
- performance characteristics
- intended use
You may need to change the drug you use, or pay more for it. You can also ask for an exception.
If you use a drug that isn’t on your plan’s drug list, you’ll have to pay full price unless you qualify for an exception. All Medicare drug plans have negotiated to get lower prices for the drugs on their drug lists, so using those drugs will generally save you money.
Discounts for Brand-Name Prescription Drugs in 2023
To lower costs, many plans offering prescription drug coverage place drugs into different “tiers” on their formularies. Each tier costs a different amount.
Generally, a drug in a lower tier will cost you less than a drug in a higher tier.
- Tier 1: low copayment is most generic prescription drugs
- Tier 2: medium copayment is preferred, brand-name prescription drugs
- Tier 3: high copayment is non-preferred, brand-name prescription drugs
- Specialty tier: highest copayment is very high cost prescription drugs
In some cases, if your drug is in a higher tier and your prescriber thinks you need that drug instead of a similar drug in a lower tier, you or your prescriber can ask your plan for an exception to receive a lower coinsurance or copayment for the drug in a high tier.
Shifting the Cost of Medication to the Drug Companies in 2023
Starting on January 1, 2020, the Donut Hole was closed completely.
The Donut Hole, which has been around since Medicare Part D began back in 2006, was initially created to keep down the overall out-of-pocket costs for Medicare recipients and the federal government.
But for those on Medicare who rely on brand-name prescriptions, it has been more of a disadvantage than a benefit. Beneficiaries were forced to choose between paying for expensive medication that worked well or paying less for medication that wasn’t as useful for treating their health condition.
How Medicare is Saving People Money in 2023
Medicare drug coverage includes drugs, like buprenorphine, to treat opioid use disorders. It also covers drugs, like methadone, when prescribed for pain. However, Part B now covers methadone when you get it through an opioid treatment program.
Additionally, If you take insulin, you may be able to get Medicare drug coverage that offers savings on your insulin. Savings can be as great as only paying $35 for a month’s supply.