Show updates...
Health Benefits

Medicare Part D: Changes under COVID-19

T + T

Summary

Among other changes, Medicare Part D plans must cover formulary drugs at out-of-network providers, cover up to a 90-day supply of prescription drugs, and make other needed changes to ensure beneficiaries can access their medication.

If you are a Benefits Plus subscriber, for additional information on Medicare Part D, refer to Benefits Plus, Health Programs, Medicare Part D. For subscription information visit: https://bplc.cssny.org/home/subscription_options.

Changes in Part D Plan Requirements

Part D plans must:

  • Cover formulary Part D drugs filled at out-of-network pharmacies
    • Part D plans must do this when beneficiary cannot be expected to get covered Part D drugs at an in-network pharmacy.
  • Cover up to 90-day supply of the prescription (or the length of the prescription, whichever is shorter) at the beneficiary’s request
    • During the emergency, all Medicare Advantage and Part D stand-alone plans must cover up to a 90-day supply of a drug, as long as they have a prescription for that amount, when a beneficiary asks for it.
    • Plans cannot use quantity limits on drugs that would prevent a beneficiary from getting a 90-day supply, if they have a prescription for that amount.
    • However, some safety limits are still in place to prevent unsafe doses of opioids.
  • Make other needed changes to ensure beneficiaries can access their medication without interruption
    • Plans have different options for how to do this, such as lifting restrictions that prevent a beneficiary from filling a prescription too soon.
      Medicare has also given plans the flexibility to make optional changes. These optional changes include:
  • Removing prior authorization requirements for certain services
  • Relaxing restrictions on home or mail delivery of prescription drugs
  • Relaxing restrictions on refilling prescriptions too soon
  • Making mid-year changes that would provide more generous coverage (lower cost-sharing) or adding additional benefits
  • Not disenrolling beneficiaries who:
    • Fail to pay premiums
    • Live outside of plan service area for more than six months
    • No longer qualify for specialized type of plan known as Special Needs Plan (SNP)

Every Medicare Advantage and Part D stand-alone plan is different. Beneficiaries should contact their plan directly to learn about how it covers services related to coronavirus.