The current structure of the Medicare Part D program affects some of our most vulnerable neighbors—especially older adults living on a fixed income. For them, the burden of high out-of-pocket costs for their medications can mean difficult choices between getting treated or paying for daily living expenses—things no one should have to worry about.
Use this Medicare Part D FAQ to equip yourself with answers to the most commonly asked questions about this critical issue.
What is Medicare Part D, and where can I go to learn more about it?
Medicare Part D is an optional prescription drug program for people on Medicare. The structure of Medicare Part D plans can be complex, but there are resources to help you understand and enhance your prescription coverage.
Medicare Part D plans talk a lot about formularies and tiers. What does this mean?
A drug formulary is a list of specific prescription drugs that are covered by a health insurance plan, which includes drugs that are preferred because of efficacy and cost.
Most Medicare Part D plans categorize the medications they cover into groups called “tiers.” Most formularies have three to five tiers, and more expensive drugs are placed in higher tiers.
To learn how formulary tiers affect your out-of-pocket costs, check out the helpful reference sheet we’ve put together here.
My healthcare provider prescribed an expensive brand-name medicine for me. I can’t afford it. What should I do?
We understand it can be difficult to discuss finances with your healthcare provider, but we want you to feel empowered to speak up and push back.
Don’t be afraid to ask your doctor, pharmacist, social worker or healthcare provider for advice on where to find financial assistance.
We created a tip sheet with questions to help you get the conversation started. Check it out here.
If I can’t afford the out-of-pocket costs for prescription medications, where can I turn for help?
When insurance is inadequate, certain charitable organizations like PAN can help reduce your out-of-pocket medication costs.
If we are unable to assist you with your out-of-pocket costs for prescription medications, one of the following organizations* may be able to help:
*Please note that this resource list is intended to serve as a reference guide only and does not indicate PAN’s support of any particular organization. PAN cannot determine or guarantee whether patients will be eligible for assistance from these organizations.
I believe the Medicare Part D program needs to be changed to make prescription medications affordable for people with life-threatening, chronic and rare diseases. How can I get in touch with my member of Congress to share my concerns?
The PAN Foundation has created a simple tool to send a pre-written email to your representatives in Washington. Click here to take the next step!