Drug Coverage

The Parkinson’s Action Network is the leading voice for patient advocacy in Washington, DC working in coalition on important issues, such as Medicare drug coverage. PAN is a member of MAPRx, a coalition of patient, family caregiver and health professional organizations committed to safeguarding the well-being of patients with chronic diseases and disabilities under Medicare Prescription Drug Coverage. MAPRx consults consult with the Centers for Medicare and Medicaid Services (CMS) on the topic of how to best communicate drug coverage information to beneficiaries, particularly on behalf of America’s most vulnerable Medicare beneficiaries.

What is Medicare Prescription Drug Coverage (Part D)?

Medicare prescription drug coverage, also known as Medicare Part D, is insurance that covers both brand-name and generic prescription drugs. The prescription drug benefit coverage is provided through third-party companies, known as Prescription Drug Plans (PDP). Coverage is available to those beneficiaries who choose to enroll in a PDP, meet the deductible, and pay a monthly premium. Medicare will then pay for part of the cost of those drugs that are on the chosen plan's drug formulary.

Every year, Medicare beneficiaries have the opportunity to enroll in or change their PDP. The Annual Enrollment Period for Part D runs from Oct. 15 to Dec. 7. Coverage then starts in January. Individuals who are already in a plan should decide whether it will be right for them in the coming year; if they do not switch they will remain in their current plans. All plans have different costs and benefits from year to year. It is crucial for all beneficiaries to carefully review their options and make the best choices for the coming year.

To learn more about enrolling in or changing prescription drug plans, please consult the following resources:

What is the Coverage Gap (Donut Hole)? 

The Medicare Part D drug benefit does have a coverage gap, known as the “donut hole,” where Part D enrollees are responsible for paying 100% of total drug costs until they reach the catastrophic coverage level. The Affordable Care Act includes a provision that will eliminate the donut hole coveerage gap by 2020. Learn more.