Prescription Drug Plans

PDPs are available from various companies in New York State but which one do you choose? There are really only two factors, monthly premium and drug formulary.

Premiums for PDPs range from Wellcare’s value plan which is only $4 per month up to $135 for Humana’s Premier RX Plan. For lower income beneficiaries, the state may put for up to $42 of these premiums. There is another state pharmaceutical program in NY called EPIC, which I will discuss in a later post.

Before enrolling though, be sure to check the drug formulary of the plan you choose. I have software that is able to check my client’s drugs with each plan and give a quote for the copays for each drug from month to month. Each company categorizes each drug as a certain tier level, and each tier level corresponds with a copay.

Another factor, to a lesser degree, is the pharmacy network. You would want to fill your drugs from a “preferred pharmacy” to get the lowest copay (CVS, Walgreens, Rite Aid, etc). Nowadays, all of these insurance companies have their own mail-order pharmacy that offers the best prices to members.