Etini Willie
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The initial coverage stage of Medicare part 4 is a stage where a patient that holds a Medicare part 4 insurance plan pays a certain part of the cost of the drugs while the insurance company pays the other part. In this initial coverage stage, drugs are divided into tiers. And the cost splitting provisions are different for each tier. Let's explore the tiers:
Tier 1- This has the lowest co-payment for drugs bought. This category consists of generic drugs. A generic drug is a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use. Example is metformin used to control diabetes.
Tier 2: These are preferred brand name drugs. Co payments for this drugs are in the medium range. A drug sold by a drug company under a specific name or trademark and that is protected by a patent.
Tier 3- These have higher co payments. They are non preferred brand name prescription drugs. Non-preferred drug means a drug on the MTUS Drug List which is designated as requiring authorization through prospective review prior to dispensing the drug.
Tier 4- High cost prescription drugs. They have the highest co payments.
So those are the tiers of drugs available on Medicare part D initial coverage.
Tier 1- This has the lowest co-payment for drugs bought. This category consists of generic drugs. A generic drug is a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use. Example is metformin used to control diabetes.
Tier 2: These are preferred brand name drugs. Co payments for this drugs are in the medium range. A drug sold by a drug company under a specific name or trademark and that is protected by a patent.
Tier 3- These have higher co payments. They are non preferred brand name prescription drugs. Non-preferred drug means a drug on the MTUS Drug List which is designated as requiring authorization through prospective review prior to dispensing the drug.
Tier 4- High cost prescription drugs. They have the highest co payments.
So those are the tiers of drugs available on Medicare part D initial coverage.
