Medicare doesn’t cover (pay for) all prescription drugs. Each Medicare drug plan has its own list of drugs (called a "formulary") that are covered by the plan. The formulary will include generic and brand-name drugs. The plan’s formulary must meet Medicare’s requirements.Check to see if the plan covers your prescription drugs. Browse Any Medicare PDP Formulary
Even if a drug is on the plan’s list, there may be special rules for filling a prescription. For example, you or your prescriber may need to get permission from the plan (prior authorization) to use the drug before it is covered. The plan may ask you to try another drug before it will cover the drug that was prescribed for you (step therapy). Also, the plan may limit the number of pills or dose prescribed (quantity limits). See How Your Drug is Handled by all PDP Plans
In addition to these special rules, the plan’s formulary can change during the year because drug therapies change, and new drugs and medical knowledge become available. If there is a formulary change that affects a drug you take, your plan will notify you at least 60 calendar days in advance. You will then have an opportunity to request an exception. See below for more information.
There may be times when you disagree with a coverage or payment decision made by your Medicare drug plan. This section explains your options and the steps you need to take if you disagree with your Medicare drug plan.