What if my drug is not on my Part D plan's formulary?

Table of Contents Getting Started:
The Basics About Enrolling Costs and Coverage Problems Getting Prescriptions Filled Other Problems & Changing Plans Information for Medicare Providers

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What if my drug is not on my Part D plan's formulary?

First, contact your doctor.

Explain to your doctor that your Part D plan refused to cover your drug because it was not on its formulary. Find out whether your doctor will prescribe a substitute drug that is on your Part D plan's formulary.

If your doctor believes that you must have the prescribed drug, then ask your doctor to contact your Part D plan to request an "Exception" and to explain why your drug is medically necessary.

NOTE: You have a RIGHT to request an Exception.

Get more information about requesting an Exception.

Content provided by Maine Legal Services for the Elderly

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