Medicare part “D” prescription drug policy

[JameswB3408]

Back in December I renewed my Medicare part “D” prescription drug policy for 2023. Before I renewed it, I checked the Medicare web site to see if all the drugs tant I am using are still covered by my plan, they all were covered. Today in the mail I have received a letter from my insurance provider advising me that they are changing the “formulary” of my plan. This change renders one of my covered drugs to be no longer covered under this plan. I called my provider's help line, and they told me that I need to have my doctor send them an “authorization request.” I did so. the response from my provider was the same, “the drug is not covered now.” What do you think, should be my next move? Please advise. 

[RichardW604749]

Be sure to look into GoodRX and similar plans. They often have lower prices than the insurance copay/

[GailL1]

The insurer does have the right to change their formulary, things happen - usually they give a reason for the change - like perhaps a generic version has been approved or another drug has been added to their formulary that took the place of the one they are dropping.  

Medicare Part D has an exception appeals process - I think that is what your doctor should have filed.  This is the appeals process as described by Medicare.  It should also be covered in your insurers EOC (Evidence of Coverage)

Medicare.gov Medicare prescription drug coverage appeals

[AARPJanelleM · Accepted solution]

@JameswB3408 Thank you for reaching out to AARP! You may find this document helpful:  "Medicare Prescription Drug Coverage: How to File a Complaint, Coverage Determination, or Appeal"  https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11112.pdf   

Also, here is a link to the Medicare site that discusses Rx coverage appeals: https://www.medicare.gov/medicare-prescription-drug-coverage-appeals