PEBB Medicare Part D plans

PEBB plans that include Part D

• Kaiser Permanente NW Senior Advantage with Part D
• Kaiser Permanente WA Medicare Advantage with Part D
• Uniform Medical Plan (UMP) Classic Medicare with Part D (PDP)
• UnitedHealthcare PEBB Balance
• UnitedHealthcare PEBB Complete

Advantages to Medicare Part D plans

Medicare Part D plans are subject to the Inflation Reduction Act (IRA) of 2022, which introduced several changes to Part D intended to lower costs, including:

• A yearly out-of-pocket maximum
• Eliminating the “donut hole” gap in coverage.
• A six percent limit on yearly base premium increases.
• Medicare’s ability to negotiate with drug manufacturers for some costly brand-name drugs.

Member benefits include:

• Prior authorization and step therapy requirements are generally less restrictive.
• By Law, Part D appeals must be resolved in 72 hours (24 hours for urgent appeals).

Covered drugs

Each Part D plan negotiates its own list of covered drugs (formulary). These drugs are grouped into price tiers that usually include preferred and nonpreferred generic drugs and brand name drugs.

All Medicare drug plans generally must cover at least two drugs per drug category but plans can choose drugs they will cover. Medicare also has six protected classes of drugs, for which all or nearly all drugs are covered by Part D. They are antidepressants, antipsychotics, anticonvulsants, immunosuppressants, antiretrovirals, and antineoplastics.

See the plans’ formularies

• Kaiser Permanente NW Senior Advantage with Part D
• Kaiser Permanente WA Medicare Advantage with Part D
• UMP Classic Medicare with Part D
• UnitedHealthcare PEBB Balance and PEBB Complete

Cost of prescriptions

Contact your plan to learn about formularies and out-of-pocket costs.

Restrictions

Enrollment

To be enrolled in a Medicare Part D plan, you must permanently live in the United States. Medicare Part D does not cover drugs purchased outside the U.S. and will not reimburse you for any drugs purchased in other countries.

Using manufacturer coupons

You cannot use manufacturer coupons for your prescriptions. A federal law called the Anti-Kickback Statue (AKS) makes it illegal for drug companies to give money or other incentives to Medicare patients to purchase drugs. This is why you cannot use manufacturer coupons with a Part D plan. Federal subsidies and manufacturer discounts already cover a significant portion of drug costs for Part D plans, which results in lower premiums.

Savings with Medicare Part D coverage

Consider these strategies to help save on prescription costs:

• Medicare Part D Extra Help program. Based on your income and other factors, you may qualify for help with paying your monthly premium, yearly deductible, and prescription copayments. Extra Help can also count toward your out-of-pocket costs.
• Medicare Prescription Payment Plan. If you think you will reach the $2,000 out-of-pocket maximum, you may be interested in the Medicare Prescription Payment Plan. This option can help you manage your out-of-pocket costs for covered drugs by spreading them across the calendar year.
• Ordering a 90-day supply of your prescriptions through your plan’s mail order pharmacy. For many plans, a 90-day supply of covered drugs costs only twice as much as a 30-day supply. Note: Most plans limit specialty drugs to a 30-day supply. Contact your plan for details.

IRMAA

If your income is above a certain level, the Social Security Administration (SSA) determines the Income Related Monthly Adjustment Amount (IRMAA) you may pay in addition to your Medicare Part B and Part D premiums. Contact the SSA for specific information on your IRMAA. Learn more at Medicare Interactive: Part D costs for those with higher incomes.