What Should You Do When Your Part D Prescription Drug Plan No Longer Covers Your Rx?

What should you do when your Part D Prescription Drug plan once covered the prescription you currently take but no longer lists it as a covered drug for the current year?

You are entitled to a transition refill or transition fill, which is a one time, 30-day supply of a drug that Medicare drug plans must cover. Transition fills only apply to a drug that you were taking before the plan stopped covering it. You are eligible for a transition fill because your plan took the drug off its formulary (list of covered drugs). You have 90 days from the date the formulary changed (usually January 1) to request a transition fill.

To access your transition fill, your pharmacist will need to call your Part D plan. She or he will explain you want to exercise your transition refill and ask that the plan cover the drug without any restrictions.

Once you get your transition fill, you should speak with your doctor about switching to a drug that is on your plan’s formulary without restrictions. If there is no other drug that will work for you, you can submit a request for an exception to your Part D plan’s formulary. This means you are formally requesting to have your prescription drug covered by your plan. Once you have used your transition fill and while you are waiting for a decision on your request for exception, your plan must provide temporary refills until a decision has been made.