Anyone enrolled in Medicare prescription drug plans should carefully review any changes to Medicare Part D annually.
Alzheimer's patients should pay particular attention to prescription drug changes. Many plans specify covered medications by brand name and have imposed quantity limits on certain Alzheimer's drugs. Quantity limits restrict the number of pills an individual can receive over the course of a period of time. For example, a quantity limit could be 60 pills for a one month period. Of the new restrictions, the Alzheimer's Association says, "We have raised the issue with the Medicare agency and have been told that there should not be less than the upper amount of drugs approved by FDA."
It is important to review any changes to the plan as they relate to any changes in your health plan, especially the list of covered drugs. For family members with Alzheimer's disease, the Alzheimer's Association recommends that caregivers consider the following important factors before making a decision about which drug plan is right for your loved one's needs:
- Each plan has a list of drugs for which it will pay. This is called a formulary. Are your Alzheimer drugs on the formulary? At least two cholinesterase inhibiters and memantine must be on every plan formulary.
- Does the plan cover the doses of the drugs that you take? Check the plan formulary to make sure it covers the actual doses that you take.
- Do the plan's rules or policies limit coverage of your Alzheimer drugs by requiring prior approval or by requiring you to try a less expensive, similar drug before the plan will pay for your drugs?
- Are there limits on the number of pills that a prescription may cover ("quantity limits") over a specific period of time?
If you or your loved one decides to make changes to Medicare drug coverage, the time to do it is during Medicare Open Enrollment.