Medicare Drug Plans Change Coverage for Alzheimer’s Medications

All Medicare prescription drug plans made changes for 2012. Anyone enrolled in a drug plan in 2011 should have received a letter explaining what changes were made for 2012.

For example, the change that is most relevant to people with Alzheimer's disease is that most plans have either taken Aricept off their lists of covered drugs, or they are only covering the high-dose Aricept 23 mg. In addition, most plans have imposed Quantity Limits on Alzheimer's drugs. Quantity limits restricts 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."

Due to the changes, it is important to review the changes, 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?
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