If one of your medications is no longer covered by your Medicare Part D prescription drug plan, there are at least three steps you can take at this time:
(1) If your medication is not
excluded from the Medicare program, you can ask your Medicare prescription drug plan for a one-time,
transition fill or temporary supply of your medication for 30 days. You can
click here to read more about transition fills.
(2) While you are using your 30-day temporary medication supply (
transition fill), you and your physician can look for a generic equivalent or an alternative medication that is included on your Part D plan’s formulary.
Tip: See the information below about our
Formulary Browser and to learn more about reviewing
your plan’s drug list online.
(3) If you cannot find an alternative medication on your plan's formulary, you can file a
formulary exception request with your Medicare Part D plan asking that your non-formulary medication be covered under your current Medicare plan.
Click here to learn more about requesting a formulary exception or you can
click here to learn about the prescribing physician’s role in the formulary request process.
Important reminder: Remember that your transition fill is only for a 30-day supply, so start working with your prescriber right away to find an alternative medication or file a formulary exception request.
Also, formulary exception requests are not “automatically” granted.
If your formulary exception request is denied, you have the right to
appeal your plan’s decision a number of times, ultimately with a review by an independent group. You can
click here for an overview of the appeals process.
Question: Is there a quick way for me to see the medications covered by my Medicare prescription drug plan?
Yes. We have an online
Formulary Browser that lets you browse through any Medicare Part D (PDP) or Medicare Advantage (MAPD) plan drug list.
1. To begin, you can
click here or go to
FormularyBrowser.com.
2. Select either PDP (drug only plans) or MAPD (health and drug plans),
then choose your state, the name of your Medicare plan provider (such
as AARP or Humana), and click “Search”.
3. Next, choose the specific name of your Medicare plan as offered by
your provider (such as the AARP MedicareRx Preferred plan), and click
“Search” again.
You can then browse alphabetically through the plan’s entire formulary (the letter “A” is chosen by default).
Please notice that in the search box, you see the formulary drug tiers
and the number of drugs on each tier, and you can hide tiers from the
results, for example, if you only want to see Tier 1 drugs.
The results will show you the medication name, the drug tier, the cost-sharing at a preferred network pharmacy, and any
drug utilization management restrictions.
You can click on the 30- or 90-day cost-sharing figures (such as $10.00 for Tier 1 drugs in Florida) to see additional pricing details and the average retail cost history.
As an example, you can
click here to browse the Florida AARP MedicareRx Preferred formulary (just change the state and plan information to whatever you want).
Reminder: Both our
Formulary Browser (showing all drugs for a single Medicare plan) and our
Drug Finder (showing all Medicare plans covering a single drug) display the drug cost-sharing information, along with the details of the
drug utilization management restrictions (for example, Q: 30/30Days for a quantity limit) for all Medicare Part D plans and Medicare Advantage plans.
Tip: If you are browsing plans using our Medicare Part D or Medicare Advantage plan search tools (
PDP-Finder.com or
MA-Finder.com), the right-hand column of the results chart, shows a “
Browse Formulary” link taking you directly to your chosen plan’s online formulary.