If one of your
medications is not covered by your Medicare Part D prescription drug plan, there are
at least three steps you can take:
(1) Ask for a temporary drug supply: If you are still in the first 90 days of your plan coverage, you may be able to ask your
Medicare prescription drug plan for a one-time,
transition
fill or temporary 30-day supply of your medication. Remember,
your medication cannot be a drug that is
excluded
from the Medicare program. To initiate a transition fill
request, call the toll-free Member Services telephone number found on your
Member ID card. You can
click here to read more about what is required to get a transition fill.
(2) Search for an alternative formulary drug: While you are using your 30-day temporary medication supply (
transition
fill), you and your physician can look for an alternative medication
(such as an equivalent generic or brand name drug) that is included on your Medicare Part D plan’s formulary (you can use our online
Formulary Browser to review your plan’s drug list online).
Important reminder: Your transition fill is only for a 30-day
supply of an existing prescription, so start working with your prescriber right
away to find an alternative medication or file a formulary exception request.
(3) File a Formulary Exception request for coverage of a non-formulary drug. If you are prescribed a new medication and you cannot find an alternative medication on your Medicare drug plan formulary,
you can file a
formulary
exception request (a type of coverage determination) with your
Medicare Part D plan. In essence you are asking that your non-formulary medication be covered by your Medicare plan - you are actually adding your non-formulary drug to your Medicare drug plan formulary.
Click
here to learn more about requesting a formulary exception or you can
click
here to learn about the prescribing physician’s role in the formulary
exception request process.
Important: Formulary exception requests are not “automatically” granted. If
your formulary exception request is denied, you have the right to
appeal your plan’s decision a number of times, ultimately with a review by an independent group. You can
click
here for an overview of the Medicare Part D appeals process.
Related Questions:
Source includes:
U.S. Department of Health & Human Services