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Living With HIV? "Shop Around" for Medicare Part D Plans (Editor's Pick)
Sep 14, 2015

With respect to your recent answer to a person about paying for drugs on Part D of Medicare, and being a recent age 65 person myself, I would tell him to shop around when selecting his Part D provider. Some of them have different policies with respect to HIV drugs and their formularies, and which "tier" of co-pay will be ascribed to each drug. He might find one that better meets his needs less expensively.

Response from Mr. Chambers

You are absolutely correct, and if I didn't emphasize the importance of shopping for Part D plans, I should have. Every plan can set its own formulary and tier in which to put each medication. Plan D law requires all plans to cover "essentially all" antiretrovirals. However, most HIV+ persons are on many more medications than just antiretrovirals, so plans need to be compared. has a good comparison program as far as it goes. Click on "Find Health and Drug Plans." I prefer the General Search, and I use the ZIP code of the pharmacy I want to use rather than the home ZIP.

However, even that information needs to be confirmed as plans can change their formulary any time they wish. Try to find a current formulary on the insurance company's website and see if it is more current. If you are on ADAP (AIDS Drug Assistance Program) you need to focus on your medications which are not on the ADAP formulary.

Thanks for the reminder.


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