Ask the Pharmacist: Medicare Part D Tips

Nov 7, 2012

Selecting a Medicare Part D plan is overwhelming -- with deductibles, formularies, networks and the donut hole. Express Scripts can help.

  • Medicare
  • Seniors
  • Caregivers

People are wired for inattention and inertia.

That could explain why many people selecting their health benefit for the upcoming plan year do not make the time to carefully review and select their benefit options, as reported last month by the Associated Press.

Could that also be the reason why 84%* of Medicare beneficiaries wait until the last two weeks of the open enrollment period to select their Part D plan? Enrollment data from Express Scripts show that seniors wait until the last minute to enroll in a plan, and more than half will try to enroll on “Medicare Monday” – the Monday after Thanksgiving.

Selecting a Medicare Part D plan can be overwhelming with all the deductibles, formularies, copayments, networks and the infamous “donut hole.” But, not taking the time to carefully review and compare plans, waiting until the last minute, and trying to enroll on the busiest cyber shopping day of the year are some of the biggest mistakes Medicare beneficiaries make each enrollment period. And those mistakes can have a big impact on their wallets.

To help make the process easier for beneficiaries – or for those caring for a beneficiary – here are a few tips for what to look for in a Part D plan:

  1. Look beyond the sticker price:

    Lower premiums don’t always mean better value. Evaluate any additional out-of-pocket costs; and most importantly, make sure your medications are included on the plan’s formulary.

  2. Mind the coverage gap:

     Look for a plan that alerts you when you’re getting close to the gap. If you use a lot of medications or have reached the gap in previous years, consider a plan that offers gap coverage. Some plans offer $0 copayments for generics from the first day of coverage through the coverage gap.

  3. Generics:

    Use generic drugs whenever possible to lower your monthly drug costs and delay reaching the gap. Some plans, like the Express Scripts Medicare Choice Plan, offer a $0 copayment on generics ordered through home delivery. Many popular brand-name medications, such as Lipitor®, are now available in generic form, which is great news for Medicare consumers.

  4. Consider a plan’s CMS star rating:

    It’s an objective comparison of important plan attributes and performance, such as patient safety and member experience. The CMS star ratings range from one to five, with four and five representing above-average plan performance.

  5. Don’t delay:

    Start comparing plans now and enroll early. Waiting could lead to hasty decisions, long hold times and a delay in getting plan information in time to order medications. Enrollment began Oct. 15, and the new deadline is Dec. 7. You can sign up for free enrollment reminders at

* Based on an analysis of Express Scripts Medicare Prescription Drug Plan 2011 enrollment data. Express Scripts Medicare Prescription Drug Plan is a Medicare-approved Part D sponsor.

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