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What does non-creditable coverage mean?

Non-creditable coverage: A health plan's prescription drug coverage is non-creditable when the amount the plan expects to pay, on average, for prescription drugs for individuals covered by the plan in the coming year is less than that which standard Medicare prescription drug coverage would be expected to pay.

What is meant by Tier 4 drug?

Tier 4. Nonpreferred drug. These are higher-priced brand name and generic drugs not in a preferred tier. For most plans, you'll pay around 45% to 50% of the drug cost in this tier.

What does it mean when drug coverage is not creditable?

A group health plan's prescription drug coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of standard Medicare Part D prescription drug coverage. Prescription drug coverage that does not meet this standard is called \u201cnon-creditable.\u201d

What was the impact of the Medicare Prescription Drug Improvement?

Summary: Implementation of MMA has affected the entire healthcare continuum by reducing pharmaceutical reimbursement rates and health system revenues and increasing prescription drug copayments, emergency department visits, and hospital admissions.

What if my drug is not on the formulary?

If a medication is \u201cnon-formulary,\u201d it means it is not included on the insurance company's \u201cformulary\u201d or list of covered medications. A medication may not be on the formulary because an alternative is proven to be just as effective and safe but less costly.

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