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How drug coverage phases work

By now you probably have a good idea of what Medicare Part D is and the difference between PDP and MA-PD plans. The next step is understanding how Medicare Part D works.

It's important to note that the level of coverage you have under your Medicare prescription drug plan may change throughout the year. This change depends on which stage of coverage you are currently in. Learn more about the stages of coverage below.

Deductible phase

Before Gap, or Initial Coverage Phase

During Gap, or Coverage Gap Phase

After Gap, or Catastrophic Coverage Phase

Retail pharmacy

Drug pricing at your preferred neighborhood pharmacy. Costs are for a 30-day supply.


Mail order pharmacy

It may be cheaper to get medications home delivered. Mail Order prescriptions costs are for a 90-day supply.

Drug Restrictions

Many drug plans use rules, programs and restrictions to help control costs and ensure patient safety, which you should be aware of.

PAPrior authorization

QLQuantity limits

STStep therapy