Medicare Prescriptions: Frequently Asked Questions

Original Medicare (Parts A & B) does not cover most prescription drugs. You need Part D or a Medicare Advantage plan with drug coverage. Part D is available through standalone plans (with Original Medicare) or as part of Medicare Advantage.

A formulary is the list of drugs covered by a Part D or Medicare Advantage drug plan. Drugs are organized into tiers with different costs. Formularies vary by plan—verify your medications are covered before enrolling.

The coverage gap was a phase where you paid more for drugs. Starting in 2025, the Inflation Reduction Act caps Part D out-of-pocket costs at $2,000 annually, effectively eliminating the coverage gap for most beneficiaries.

Use generic medications when possible, compare Part D plans annually for your specific drugs, use preferred pharmacies for lower copays, consider 90-day mail-order supplies, and check Extra Help eligibility for premium and copay assistance.

Generally, you can only change Part D plans during Annual Enrollment. However, if your plan drops a drug or you qualify for Extra Help, you may have a Special Enrollment Period. You can also request a formulary exception from your plan.