If your medications are not covered by your Medicare Part D plan, review the plan’s formulary (covered drug list) to confirm whether the drug is excluded, requires prior authorization, or is placed in a higher cost tier. You can request a formulary exception if your doctor determines the medication is medically necessary, or ask about a covered alternative.
If coverage is still not appropriate, you may switch to another Medicare Part D or Medicare Advantage plan during the Annual Enrollment Period (October 15–December 7) or if you qualify for a Special Enrollment Period. Because formularies and pharmacy networks can change annually, reviewing your drug coverage each year is important.