Besides dropping a medication from my formulary, what other changes can my Medicare prescription drug plan make to my formulary during the year?

Medicare Part D prescription drug plans can update their plan formularies or drug lists throughout the plan year and - besides removing a medication from your Medicare Part D plan’s drug list - your Medicare prescription drug plan can make the following changes during the plan year:

add new medications to your formulary,
change usage management restrictions for a formulary medication,
move a medication to a lower cost-sharing tier, or
move a drug to a higher cost-sharing tier.

The good news is that most of these mid-year formulary changes will not affect you during the current Medicare Part D plan year.

When will changes to your drug list affect you?

If any of the following types of changes impact a formulary drug you are currently taking, the formulary change will not affect you until January 1st of the next year, that is, if you decide to stay in your current Medicare Part D plan:

your drug is moved into a higher cost-sharing tier.
new restrictions (such as Quantity Limits or Prior Authorization) are added on the usage of your drug.
your drug is removed from the Drug List - but not because of a sudden recall - or because a new generic drug has replaced it.

However, in some cases, you will be affected by the coverage change before January 1:

If a brand-name drug you are taking is replaced by a new generic drug, your plan can make the change immediately and without notifying you. However, if your medication is replaced with a medication that has been on the market (not new), your plan must provide you with a 30-day notice of the formulary change or a 30 day refill.
- During this 30-day period, you should be working with your provider to switch to the generic or to a different drug that is covered.
- Or you and your prescriber can ask your plan to make an exception and continue to cover the brand name drug for you. Learn more about Formulary Exceptions (Coverage Determinations), Appeals & Grievances
If a drug is suddenly recalled because it’s been found to be unsafe or for other reasons, your Medicare Part D plan will immediately remove the drug from their Drug List.