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Medicare Landscape

April 25, 2023 - 2 MINUTE READ

The recent changes made to Medicare Part D will eventually make prescription drugs more affordable but what is Medicare doesn’t cover your specific drug? Coverages vary by plan, and you may not be able to switch immediately to a plan that covers your drug. There are options to consider if your prescription isn’t covered by your Medicare plan.


Talking to your doctor is a good first step to see if there is a similar medication that is covered by Medicare or Medicare Advantage, or if there are any alternative treatments available. 1There are a couple of different exceptions you can formally request, one being a formulary exception. This is where your physician signs off on why you need the drug, and that it is a medical necessity. 1The 2nd option is to request a tiering exception, this is where your Medicare plan covers your drug but places it at a higher price than you’d like. You may be able to switch to a better plan if you qualify for a special enrollment period.


1Medicare’s open enrollment period is from October 15th to December 7th each year. This is where you can find a plan that covers your prescription drug using Part D or a Medicare Advantage plan. There are lots of resources out there that help you make the best decision when it comes to your Medicare options.



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