What if Your Medicine is Not Covered?

If you have a new medication during the year that is not covered, you have a couple of options within your plan. There is a form required to be provided by each plan that is called a Request For Exception Form.

You can complete this with your doctor to request that they cover a medication not on the formulary, or grant an exception to a restriction or quantity limit.

This exception may or may not be allowed, but they will respond in writing in a timely manner as required by Medicare. My experience has been if they do add a medication for you it is usually at one of the highest tier levels.

If it is a type of medication that Medicare doesn’t cover, then you will have to look at options for the general public. There are many patient assistant programs you may qualify for. You can find these programs by doing an internet search using your medication name and patient assistant program in the search.