Question 1

What are drug tiers?

Accepted Answer

Medicare Part D plans organize drugs into tiers, typically 1 through 5. Tier 1 (preferred generics) has the lowest copay, while Tier 5 (specialty drugs) has the highest. Lower tiers mean lower out-of-pocket costs for you.

Question 2

What is prior authorization?

Accepted Answer

Prior authorization means your doctor must get approval from the plan before the drug is covered. This is common for expensive or specialty medications. Without approval, you may have to pay the full cost.

Question 3

What is step therapy?

Accepted Answer

Step therapy (also called 'fail first') requires you to try a lower-cost drug before the plan covers a more expensive alternative. For example, you may need to try a generic before getting approval for the brand-name version.

Question 4

What are quantity limits?

Accepted Answer

Quantity limits restrict how much of a medication the plan will cover in a given time period. For example, a plan might cover 30 tablets per 30 days. If you need more, your doctor can request an exception.

Question 5

What is the deductible phase?

Accepted Answer

In 2026, the standard Part D deductible is $615. During this phase, you pay the full cost of your drugs (unless the plan waives the deductible for certain tiers). After meeting the deductible, you enter the initial coverage phase where copays/coinsurance apply.

Question 6

What happens after the initial coverage phase?

Accepted Answer

In 2026, once your out-of-pocket costs reach $2,100, you enter the catastrophic phase where you pay $0 for the rest of the year. The coverage gap ('donut hole') was eliminated starting in 2025.

Drug Formulary Lookup

Check Your Drug Coverage

Frequently Asked Questions

Need Help Choosing a Plan?