Frequently Asked Questions about Understanding Your Formulary

Nov, 09 2022 — Yes.  Some Medicare Part D prescription drug plans cover, not only brand-name and generic prescription drugs, but also so-called "Bonus Drugs" not usually covered by the Medicare Part D program, . . .

Jan, 22 2023 — Utilization management restrictions (or "usage management" or "drug restrictions") are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs a . . .

Oct, 30 2022 — Step Therapy is a utilization management restriction that your Medicare Part D prescription drug plan can add to a formulary medication. According to the Centers for Medicare and Medicaid (CMS) "St . . .

Nov, 13 2022 — Although Ambien, was covered by many Medicare Part D carriers in prior years, it is currently covered by only a few Medicare Advantage plans (MAPD) and no prescription drug plans (PDP). Instead . . .

Jan, 22 2023 — Some medications are carefully monitored by Medicare Part D plans to ensure your safety and your plan may require that you receive prior approval or "prior authorization" before your prescription will . . .

Mar, 13 2022 — Drug Tiers are an attempt to "logically" group drugs (such as generics, preferred-generics, brand drugs, and specialty drugs) within a list (drug formulary). All of your Medicare Part D prescriptio . . .

Dec, 12 2022 — A National Drug Code (NDC) is a number that uniquely identifies your prescription medication, the drug manufacturer, the medication strength, and the packaging of your medication. An NDC can be up . . .

Aug, 09 2019 — Some abbreviations on your Medicare Part D plan's formulary are for Usage Management Restrictions or to further clarify the coverage details under your particular Medicare Part D prescription drug pla . . .

Sep, 01 2022 — Quantity Limits (QL) are a Medicare Part D plan drug utilization management tool limiting the amount of a particular drug that the Medicare Part D plan will cover during a specified time period, such . . .

Aug, 02 2022 — We include the size of all Medicare Part D prescription drug plan formularies in our stand-alone Medicare Part D Plan Finder (PDP-Finder.com) and our Medicare Advantage Plan Finder (MA-Finder.com). . . .

Nov, 26 2022 — If your pharmacist tells you that one of your Medicare Part D prescription drugs requires prior authorization (PA), you should contact your Medicare Part D plan to find out about the PA requirement an . . .

Jan, 27 2023 — Medicare Part D prescription drug plans can change their plan formulary or drug list throughout the plan year - and you may find that new Part D drugs are added - or dropped - or formulary drugs may h . . .

Sep, 08 2022 — If you have a prescription for a drug that isn't on your plan's formulary, you should ask your doctor if there is another drug you can take that is on your plan's formulary.  If your doctor can't . . .

Sep, 01 2022 — This is known as a quantity limit restriction (such as 30/30 days or 30 pills for 30 days).  You can review your Medicare Part D plan's formulary for any Usage Management Restrictions or to furt . . .

Dec, 12 2022 — Yes.  We have our Formulary Browser online that includes every Medicare Part D prescription drug plan (PDP) and Medicare Advantage plan (MAPD) formulary or drug list - and all plan formularies ar . . .

Dec, 01 2019 — A Coverage Determination is any decision made by a Medicare Part D plan regarding payment or coverage benefits to which a Medicare plan enrollee believes he or she is entitled. More specifically, . . .

Aug, 24 2021 — It depends on the type of formulary change.(1) No notice of a formulary change when replacing a brand-name drug with a new generic.Your Medicare drug plan (stand-alone Medicare Part D plan or Medicare . . .

Aug, 21 2022 — You and/or your prescriber can use our online Formulary Browser (https://FormularyBrowser.com) to check your Medicare Part D (PDP) or Medicare Advantage (MAPD) plan's drug list (formulary) for lower-c . . .

Aug, 28 2022 — No. The 75% Donut Hole discount, does not apply to Medicare Part D excluded drugs even if they are covered by the Medicare Part D prescription drug plan as a “Bonus Drug” (also known as &# . . .

Aug, 16 2022 — Indication-based utilization management (or indication limitations) is a type of utilization management that a Medicare Part D prescription drug plan can implement along with the plan's prior authoriz . . .

Jan, 27 2023 — Medicare Part D prescription drug plans can change their plan formulary or drug list throughout the plan year - and you may find that new Part D drugs are added - or dropped - or formulary drugs may h . . .

Jan, 22 2023 — Some medications are carefully monitored by Medicare Part D plans to ensure your safety and your plan may require that you receive prior approval or "prior authorization" before your prescription will . . .

Jan, 22 2023 — Utilization management restrictions (or "usage management" or "drug restrictions") are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs a . . .

Jan, 07 2023 — Some Medicare drug plans will mail printed abridged or shortened versions of the plan's complete drug list showing only a portion of the plan's covered prescriptions. Our Q1Medicare Formulary Browser will show all drugs covered by the plan along with additional coverage info.

Dec, 12 2022 — A National Drug Code (NDC) is a number that uniquely identifies your prescription medication, the drug manufacturer, the medication strength, and the packaging of your medication. An NDC can be up . . .

Dec, 12 2022 — Yes.  We have our Formulary Browser online that includes every Medicare Part D prescription drug plan (PDP) and Medicare Advantage plan (MAPD) formulary or drug list - and all plan formularies ar . . .

Nov, 26 2022 — If your pharmacist tells you that one of your Medicare Part D prescription drugs requires prior authorization (PA), you should contact your Medicare Part D plan to find out about the PA requirement an . . .

Nov, 13 2022 — Although Ambien, was covered by many Medicare Part D carriers in prior years, it is currently covered by only a few Medicare Advantage plans (MAPD) and no prescription drug plans (PDP). Instead . . .

Nov, 09 2022 — Yes.  Some Medicare Part D prescription drug plans cover, not only brand-name and generic prescription drugs, but also so-called "Bonus Drugs" not usually covered by the Medicare Part D program, . . .

Oct, 30 2022 — Step Therapy is a utilization management restriction that your Medicare Part D prescription drug plan can add to a formulary medication. According to the Centers for Medicare and Medicaid (CMS) "St . . .

Sep, 08 2022 — If you have a prescription for a drug that isn't on your plan's formulary, you should ask your doctor if there is another drug you can take that is on your plan's formulary.  If your doctor can't . . .

Sep, 01 2022 — If your drug is no longer covered by your Medicare drug plan for non-safety reasons, or if it is covered at a higher cost, your plan must let you know 30 days before the change. If you don’t get . . .

Sep, 01 2022 — Quantity Limits (QL) are a Medicare Part D plan drug utilization management tool limiting the amount of a particular drug that the Medicare Part D plan will cover during a specified time period, such . . .

Sep, 01 2022 — No.  Only Medicare Part D prescription drugs found on your formulary receive the brand-name or generic 75% Donut Hole discount. Non-formulary medications, over-the-counter (OTC) drugs, and med . . .

Sep, 01 2022 — Multi-source drug is a term used by the Centers for Medicare and Medicaid Services (CMS or Medicare) distinguish between: Generic / Preferred Multi-Source Drug and Other Drugs . . .

Sep, 01 2022 — This is known as a quantity limit restriction (such as 30/30 days or 30 pills for 30 days).  You can review your Medicare Part D plan's formulary for any Usage Management Restrictions or to furt . . .

Aug, 30 2022 — Yes, but the change may not affect you this year.  As you may know, your Medicare Part D plan’s formulary can change in a number of ways throughout the plan-year, including the addition of . . .

Aug, 30 2022 — Medicare Part D plans can change formulary or drug list designs each year and your Medicare prescription drug plan may have implemented utilization management (or drug usage management) restrictions i . . .

Aug, 28 2022 — No. The 75% Donut Hole discount, does not apply to Medicare Part D excluded drugs even if they are covered by the Medicare Part D prescription drug plan as a “Bonus Drug” (also known as &# . . .

Aug, 21 2022 — You and/or your prescriber can use our online Formulary Browser (https://FormularyBrowser.com) to check your Medicare Part D (PDP) or Medicare Advantage (MAPD) plan's drug list (formulary) for lower-c . . .