Getting Started: What are PDPs & What is Covered?

PDPs, or prescription drug plans, can vary drastically based on coverage and financial needs. To find out what is covered in a specific plan, you'll need to look at a formulary, which will come with any plan. The formulary is a list of drugs that are covered under a specific policy.

Drugs listed in a formulary are typically divided by tiers, which represent different out-of-pocket cost levels. Typically generic and brand-name drugs are separated by tiers even if they have the same purpose, because generic drugs are likely to be much cheaper for the beneficiary.

If a carrier needs to change their formulary for any reason at any point in time, they are required to tell all beneficiaries of the change. Reasons for a change can vary from a drug being taken off the market by the FDA to a change in price that the carrier no longer agrees with. The carrier is also required to inform beneficiaries of an alternative covered drug that have the same qualities that were found in the previously covered drugs.

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An Agent's Guide to Navigating