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What if I'm taking a drug that isn't on my plan's drug list or a step-therapy drug when my drug plan coverage takes effect?

 Your drug plan will provide a one-time, temporary supply of your current drug. During your first 90 days in a plan

, Medicare requires Medicare drug plans to give you and your doctor time (30 days) to find another drug on the plan's drug list that would work as well as the drug you are taking. Different rules may apply for people who move into an Institution (like a nursing home). However, if you have already tried similar drugs and they didn't work, or if your doctor determines that because of your medical condition it's necessary for you to take a certain drug, he or she can contact your plan to request an Exception as soon as you get your initial 30-day supply. If your doctor's request is approved, the plan will cover the drug.

If the exception isn't approved, you can Appeal (see Your Right to Appeal).

(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)


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