Frequently Asked Questions about Understanding Your Formulary

Jul, 04 2022 — 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 . . .

Jun, 03 2022 — 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.

Jan, 27 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 . . .

Feb, 16 2021 — To learn more about low-cost insulin coverage, you can:Contact the Medicare drug plan's Member Services Department,Review the drug plan's Evidence of Coverage document,Speak with a Medicare representa . . .

Dec, 01 2021 — 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 . . .

Jun, 05 2018 — 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 . . .

Aug, 03 2021 — 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 . . .

Jul, 03 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, 10 2021 — 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 . . .

Jan, 29 2017 — Medicare Part D plans can change formulary or drug list designs each year and with the new plan year, your Medicare prescription drug plan may have implemented utilization management (or drug usage ma . . .

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, 14 2021 — 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 . . .

Aug, 09 2019 — You may be paying full retail cost for your generic medications for a few reasons: You could be in the deductible phase of your Medicare Part D coverage and you are responsible for 100% of you . . .

Aug, 03 2021 — 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, 10 2018 — 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 f . . .

Jul, 07 2019 — Co-Payment or Co-Pay is a type of cost-sharing that refers to a fixed dollar amount you pay for a medication assigned to a logical grouping or Tier of medications. Medicare Part D plans group the . . .

May, 15 2015 — Co-Insurance is a type of cost-sharing that refers to the payment of a percentage of the medication's negotiated retail drug cost that you would pay for a medication assigned to a logical grouping or . . .

Jul, 26 2019 — As noted by the United States Food and Drug Administration (FDA): "The term “authorized generic” drug is most commonly used to describe an approved, brand name drug that is marketed a . . .

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 . . .

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 . . .

Jan, 29 2017 — 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, 10 2021 — 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 &# . . .

Apr, 05 2016 — Yes.  We now have our Formulary Browser online. Now, or anytime throughout the year, you can browse through any and all Medicare Part D plan formularies or drug lists. Our Formulary Browser . . .

Jun, 20 2016 — No. There is no limit on the amount of drugs that can be covered. However, each Medicare drug plan will have a list of the specific prescription drugs that it will cover (called a formulary), and not . . .

Jun, 20 2016 — Yes. A preferred drug list is a special list of drugs that your plan has determined are less costly and as effective as other drugs. The plan’s formulary may include preferred drugs, and you may . . .

Jun, 20 2016 — Yes. Certain drugs are excluded from the Medicare Part D program, which means these drugs can’t be provided as part of standard Medicare prescription drug coverage. Some examples of excluded dru . . .

Dec, 01 2019 — If you need a drug that is not on your Medicare Part D plan's covered drug list, or that is on the formulary - but you think it should be covered for a lower copayment, you can do the following: . . .

Apr, 28 2019 — 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 . . .

Jun, 20 2016 — If a drug is found to be unsafe, it will no longer be covered. You will get a written notice from your plan of why the drug is no longer covered, a list of other drugs that are the same type that may . . .

Jun, 20 2016 — 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 . . .