Standalone Prescription Drug Plans (Part D)

A Standalone Prescription Drug Plan (PDP) is a type of Medicare Part D plan that provides prescription drug coverage. These plans are offered by private insurance companies approved by the Centers for Medicare & Medicaid Services (CMS). Standalone Prescription Drug Plans are designed to cover medications that Original Medicare (Part A and Part B) does not cover.

Here are the key points CMS highlights about Standalone Prescription Drug Plans:

Coverage for Prescription Drugs: PDPs help cover the cost of prescription medications. They are available to people who are enrolled in Original Medicare (Part A and Part B) and want to add drug coverage to their benefits. They can also be added to a Medicare Advantage plan that does not already include prescription drug coverage.
Formulary and Coverage: Each Standalone Prescription Drug Plan has its own formulary, which is a list of covered drugs. The formulary can vary from one plan to another, so it’s important to review the list of medications each plan covers and ensure your prescriptions are included.
Plan Tiers and Costs: PDPs have different cost structures, including tiers for medications. Drugs on higher tiers typically have higher out-of-pocket costs for the beneficiary. Plans also have a deductible (which can vary by plan) and set copayments or coinsurance for medications, which can vary depending on the drug tier.
Premiums and Costs: The premiums for standalone PDPs vary depending on the plan, your location, and the level of coverage. CMS sets the standard Part D premium, but individual plans may charge higher or lower premiums based on their coverage.