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Jun, 28 2023 — 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, . . .
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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 . . .
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Apr, 03 2023 — 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 . . .
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Apr, 30 2023 — 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 . . .
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Jun, 28 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 . . .
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Jul, 03 2023 — 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 . . .
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Aug, 14 2023 — 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 . . .
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Jul, 26 2023 — 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 . . .
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May, 31 2023 — 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 . . .
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Jul, 10 2023 — 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).
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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 . . .
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Jul, 10 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 . . .
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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 . . .
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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 . . .
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Jul, 10 2023 — 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 . . .
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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, . . .
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Jun, 28 2023 — The prior notification of mid-year formulary changes will depend on the type of formulary change
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May, 04 2023 — 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 . . .
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Jul, 10 2023 — You and/or your prescriber can use our online Formulary Browser (FormularyBrowser.com) to check your Medicare Part D (PDP) or Medicare Advantage (MAPD) plan's drug list (formulary) for lower-costing d . . .
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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 . . .