What To Do When Your Drug Plan Doesn’t Cover Your Prescription

What To Do When Your Drug Plan Doesn’t Cover Your Prescription

Drug plans are covering a smaller number of drugs in 2008 than they did last year.
What happens if your drug plan won’t cover a drug you need?  You might be surprised to learn there are things you can do to ensure that your prescriptions are covered by your plan, but you need to take action.  Here are a few tips from the Medicare Rights Center:

• If your doctor will be prescribing a new medication, call your drug plan and find out if the drug will be covered.  Find out if there are any requirements for prior authorization or “step therapy” that require you to try a different drug first.

• If there are restrictions, discuss all your medications with your doctor and find out if there are generic or other drugs covered by your plan that will work for you.

• If your drug plan requires that you get prior authorization or step therapy before it will cover a drug, ask your doctor to call your drug plan and give the permission, or to file the necessary paperwork.

• If no covered drug will work, ask your drug plan for an “exception” to its formulary so it will cover the drug you require.  Your doctor must certify that the other drugs covered by your plan are not as effective or may be harmful to you.

• Make sure to use a preferred, in-network pharmacy.  Many drug plans have both “preferred” and “non-preferred” pharmacies.  At preferred pharmacies, you may pay less.  Editor’s note:  To maximize your savings, use mail order, if available, for drugs you take on a regular basis.

Sources:  The Medicare Rights Center is the largest independent source of health care information and assistance in the United States for people with Medicare.  You can learn more about MRC at www.medicarerights.org.   “Medicare Cuts Back On Drugs Covered By Part D,” Julie Appleby, USA TODAY, December 3, 2007.