What to do if your prescription needs change after joining your Medicare Part D plan.

If your prescription needs have changed since you enrolled into your current 2013 Medicare Part D plan, you can first double-check your plan’s formulary or drug list to see if your new prescription is covered by your plan. To assist you, we have all Medicare Part D and Medicare Advantage plan formularies online and you can click here for an example of an online formulary to get you started (you can then change the search fields to view your own plan’s drug list).

Next, if you find that your new prescription drug is not covered by your Medicare plan, you can ask your prescribing doctor if there are any other alternative medications (such as generic alternatives) that are covered on your Medicare plan’s formulary.

If you cannot find a suitable alternative medication that is covered by your prescription drug plan, then you can ask your Medicare Part D plan to cover the new prescription by submitting a request for a Formulary Exception or Coverage Determination.

Please note that your Medicare plan is not required to automatically grant your formulary exception request, but if your plan denies your request, you have the right to appeal your plan’s negative decision. In fact, you have the right to appeal a negative formulary request decision through a number of different stages. For more information, you can click here to read about Formulary Exceptions and the appeals process (also found at on this site).

Another alternative is to take advantage of a Special Enrollment Period (if available) and switch your enrollment to another Medicare plan that does cover your new medications. You can click here to read more about Special Enrollment Periods or click here to read about the 5-star Special Enrollment Period, allowing you to enroll in a Medicare plan with a 5-star quality rating.