Medicare
Part D drug plans
Standalone prescription drug coverage, chosen against your actual medication list rather than against the monthly premium.
- Who it suits
- Individuals
- Carriers shopped
- The whole panel
- Cost to you
- $0
Overview
What this line actually does
Part D is the part of Medicare people most often get wrong, because the cheapest premium is very rarely the cheapest year. What decides your annual cost is which tier each of your drugs sits on in that specific plan's formulary, and whether your pharmacy is a preferred one.
Every Part D plan moves through coverage stages during the year: a deductible stage if the plan has one, an initial coverage stage where you pay a copay or coinsurance, and a catastrophic stage once your out-of-pocket spending reaches the annual threshold. After the Inflation Reduction Act changes, the catastrophic stage caps what you pay out of pocket for covered Part D drugs in a calendar year.
We run your drug list through the plan finder every autumn because formularies change every January, and so do prescriptions.
How it works
From first call to in force
List every drug
Name, dosage and frequency. Generic substitutions count as different entries.
Check formularies
We compare tier placement, prior authorisation and step therapy rules across available plans.
Check pharmacies
Preferred versus standard network pharmacy pricing can move a tier-1 copay noticeably.
Model the year
Deductible, initial coverage and catastrophic stages, so the January bill is not a shock.
Re-run each October
Formulary changes are published for the coming year. We check yours against them.
What moves the number
Cost factors
| Factor | Why it matters |
|---|---|
| Tier placement | The same molecule can be tier 2 in one plan and tier 4 in another. This is the largest single cost driver. |
| Deductible | Some plans apply a deductible only to higher tiers. Others apply none at all but charge a higher premium. |
| Pharmacy network | Preferred pharmacies carry lower cost sharing. Using a standard pharmacy for a maintenance drug adds up. |
| Prior authorisation | A covered drug is not the same as an available drug if the plan requires step therapy first. |
| Late enrollment penalty | Going 63 days or more without creditable drug coverage after eligibility adds a permanent surcharge. |
Scroll the table sideways to see every column.
Related lines
Often looked at alongside this
Before you decide
Part D questions we hear most
If your question is not here, call the desk. Nobody will put you on a list for asking.
Usually yes, because the late enrollment penalty is permanent and grows with every month you go without creditable coverage. A low-premium plan is cheap insurance against that.
Historically a stage where cost sharing rose after initial coverage ended. The structure has changed under recent federal law, and Part D now includes an annual out-of-pocket cap. We show you the current stages when we run your list.
Generally only during the Annual Election Period, unless you have a Special Enrollment Period such as a move, a change in Extra Help status or a plan contract change.
Most Medicare Advantage plans do, and enrolling in a separate Part D plan can disenroll you from your Advantage plan. Check before you act.
Bring us the file. We will bring the market.
Send a census or ask one question. Either way it costs you nothing and nobody will chase you.
Independent and multi-carrier. $0 cost to work with us. No pressure scripts.