Medicare Part D reforms will make covered prescription drugs cheaper, but what if this health program doesn’t cover your prescription?
The drug you need may not be covered by any plan, or you may not be able to instantly switch to one that does. Here are some things to think about if your Medicare plan doesn’t cover a medicine your doctor has prescribed.
Examine the current state of Medicare
Check if the medicine is covered by your plan. Some medications, such as those used for weight loss, cosmetic goals, or to treat common cold and flu symptoms, are never reimbursed by the health program.
Consult your physician
Discuss with your physician whether there is an equivalent Medicare Advantage-approved medication or alternative treatment options
If there are no equivalents available, your doctor will need to vouch for your need to take the medication in question in order to help you submit an appeal.
Formulary exception request
Your prescription medication may not already be on the formulary, or list of covered medications, for your plan.
It’s possible that the request will need to be made more than once. Calling the insurance provider could provide you with the precise wording you need to make your request.
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Schedule a plan change during open enrollment
The Health program’s open enrollment period occurs annually between October 15 and December 7 and is your chance to sign up for a Medicare Advantage plan or Part D plan that meets your needs in terms of prescription medication coverage.
During its open enrollment, which occurs annually from January 1st to March 31st, beneficiaries who are enrolled in its plan have the option to switch to another Advantage plan or return to Original Medicare with a different Part D plan.
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