Commonly misconstrued as a PDP Plan. A PDP or Prescription Drug Plan is an insurance policy for exactly what the name suggests – prescription drugs. It is an insurance product under Medicare known as Part D. This covers take-home drugs usually prescribed by general doctors and healthcare physicians.
Therefore, it usually comes alongside Original Medicare Part A and B with out-of-pocket costs still applicable. After taking regulatory approval from Medicare, many insurance companies sell PDPs, including coverage for commonly prescribed medications such as Tylenol or Ibuprofen.
What Comes Under PDP Coverage?
Basically, a PDP or Part D allows outpatient prescription drug coverage. Any private health insurance company can make PDP available as part of the Medicare Advantage plan or stand-alone policies for their clients. Moreover, even though PDP has to provide a standard level of coverage set by Medicare, the drugs included or excluded can vary depending on the client’s initial Medicare plan. Therefore, clients can seek out Medicareplans that automatically resort to providing prescription drug coverage like Medicare Cost Plans, Private Fee for Service (PFFS) Plans, and Special Needs Plan (SNPs).
Included Drugs
PDP coverage usually includes prescription drugs and their costs based on certain generic and brand name details. However, there is a formal list of medicines and prescription drugs for PDPs regulated by Medicare. Each Medicare plan is mandated to allow coverage for at least two of those prescription drugs mentioned in the list under the “most commonly prescribed” mediation category. Technically, the prescription drugs and medications on that list are categorized according to how expensive the product may be. The more expensive a drug is, the higher the chances of it being in the top tier of the list.
Excluded Drugs
Contrary to popular belief, not all medications or prescription drugs make it under the PDP coverage. Certain are excluded as standardized by Medicare because, after all, Medicare is a specialized program for people above the age of 65. Hence, quite obviously, certain medications don’t apply or prove useful for that age group. So to ensure that someone may not misuse the PDP, Medicare states the following prescription drugs and medications are excluded:
- Over-the-counter medicines
- Drugs for weight loss or gain
- Drugs with cosmetic uses
- Fertility drugs
- Drugs that treat erectile dysfunction
- Prescribed vitamins and minerals
PDP Enrollment
Once you qualify for Medicare. It is a good practice to get your PDP plan. This is the best chance to avoid penalty charges due to coverage gaps. This will ensure the availability of your medications remains intact. As well as this creates options to choose from for a PDP. You can always talk to an expert about your PDP plans and their consequent benefits. Both a healthcare professional and Medicare expert should help you understand specific rules of different PDPs. Also, their coverage to save on costs and maximize benefits. As far as the penalties that can affect your cost. It makes sense to not wait until last minute to apply.
PDP Costs
Naturally, PDP comes with its own set of costs. Therefore, anyone applying for PDP shall be required to pay a certain amount based on the following:
- Their chosen plan for Medicare and then PDP.
- The drugs their insurer and healthcare professional chooses.
- Using the in-network pharmacy for purchases of drugs or not.
- The drugs that are being bought are listed in the formal list of Medicare inclusive drugs or not.
- Receiving support to pay off their PDP premium or not.
- Out-of-pocket costs
It is important to note here that according to recent news sources. In 2022 most Medicare PDP plans will have a new deductible of $460.00. Even though some plans this will not apply. This is because they have a zero Deductible.
Concluding Summary
In simple terms, PDP is an acronym for Prescription Drug Plan. While private insurance companies essentially do offer them to people with Original Medicare that is Part A and B, you can undertake PDP after checking your own plan’s coverage for necessary prescription drugs.
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