Your Medicare Part D plan is allowed to make changes
to your prescription drug plan formulary throughout the plan year. But, to protect plan members, Medicare Part D plans are restricted as to the types of changes made to a drug list.
For instance, your Medicare Part D plan is permitted to make a lower-costing generic drug substitution for a brand-name drug as a formulary “maintenance change”. In other words, since a generic drug equivalent is available, your Medicare Part D plan can replace the brand-name drug.
In fact, a Medicare Part D plan can immediately drop your brand-name drug from the plan's formulary when a new generic equivalent becomes available.
A Medicare Part D plan can also immediately remove a medication from your formulary if there is a health or safety risk related to the drug. For example, the FDA has found the drug to be dangerous.
Finally, when a prescription drug is being discontinued by the manufacturer, your plan may provide coverage until there is no longer a supply of the medication available.
Question: What can I do when a drug is dropped from my Medicare plan?
Your drug plan may inform you when one of your drugs is no longer being
covered by your Medicare plan. But unfortunately, many people learn
that their brand medication is no longer being covered when they are at
their pharmacy having a prescription filled.
If your medication is no longer being covered by your drug plan then you can
- first see if the newly-introduced generic is an adequate substitute or
- you and your prescriber can review your plan's formulary to see
if your Medicare Part D plan covers another medication that might also
work for you.
You can use our Formulary Browser to review all medications covered by any Medicare Part D or Medicare Advantage plan (Formulary-Browser.com
Please read our FAQ: Can my Medicare prescription drug plan drop medications from its drug list?
for more details about what you can do if your medication is no longer covered by your Medicare Part D plan.
And our article, Five things you can do when your Medicare drug plan drops your brand-name drug