What Can I Do If My Medicare Policy Does Not Insure My Prescription?

If you have Medicare Part Dprescription drug insurance, either as a separate Medicare Part D prescriptiondrug policy or through a Part D Medicare Advantage policy that you receive inprescription drugs, your policy may insure drugs that, in your doctor’sprofessional opinion are necessary for your treatment. Click www.medicareadvantageplans2019.org to get a quote and enroll in a medicare advantage plan to save money.

Each Medicare prescription drug policy has its own formulary that contains a list of insured prescription drugs. Theform may change from time to time, but the policy must notify you if it does.In some cases, a doctor may prescribe a medication that is not included in theformula of your policy and, therefore, is not insured. Often, the doctor cansubstitute other drugs insured by your policy to treat your condition.

However, there may be times when your Medicare drug insurance refuses to pay for a certain prescription drug that your doctor considers necessary to treat your condition. What can you do if it happens to you or someone you love so much.

What do I need to know about Medicare prescription drugs?

Medicare Part D prescription drug insurance is provided by private insurance companies approved by Medicare. Each policy may have different requirements and insurance costs. Before you fill out your prescription, you can ask your doctor if there is a generic or other cheaper equivalent that he can prescribe to treat your condition.

Medicare Part D insurance prefersgeneric drugs. Generic prescription drugs may be less expensive to payout-of-pocket. Each prescription drug policy as mentioned above, includes aformulary or list of insured prescription drugs. The formulary can be modifiedat any time, but when they do, the policy must inform you in writing. When you fill a prescription for a particular drug for the first time, you can also ask your policy for an insurance determination where you will learn:

When the drugs are insured and what you pay for them.

If there is a specific requirementthat you must meet before your benefits are applied. For example, some policiesrequire step-by-step therapy before they will insure a certain prescriptiondrug, which means that your doctor will have to try less expensive prescriptiondrugs to see if you are responding before the policy pays for a more expensivedrug.  If your policy says that your prescription drugs will not be paid for a particular drug, you can also request an exception. Your Medicare prescription drug prescription can approve an exception if:

Your doctor believes it is medically necessary to obtain a prescription drug that is not included in your policy.

Your doctor will order a moreexpensive medication because they believe that a cheaper alternative is not aseffective for you. In that case, your policy will allow you to pay less forexpensive prescription drugs.  You or your health care provider canrequest an insurance calculation or an exception to your policy. What happens if my Medicare prescription drug policy still does not pay for my drugs?