The vast majority of the most common prescriptions taken by people on Medicare are covered but there are always exceptions, some of which can be pricey. Here are the main reasons your prescriptions are not covered by your plan and what you can do:
- You’re taking a medication that simply isn’t part of the approved formulary. Formularies can change on a yearly basis so it’s important to make sure you’re well-covered for the upcoming year. The best time to do so is during the Open Enrollment Period between October 15th and December 7th.
- If you know ahead of time which medications you will be taking, make sure your drug plan covers them, or
- Speak with your healthcare provider about switching to a medication that is covered by your plan
- You need prior authorization from your healthcare provider
- Someone made a mistake → maybe your prescription got sent to the wrong pharmacy or you were given a prescription for a generic instead of a brand name
As usual, there is an exception to the rule. If your medication is not covered by your Medicare-approved drug insurance plan, you can request an exception be made.