What if I need a drug that is not covered by my Part D plan?
When shopping for a Part D plan, you need to examine each Part D plan available in your area to find the plan that best meets your prescription needs. Unfortunately, you may discover that no plan covers all the drugs that you need. Moreover, you may choose a plan based on your current medication needs, but your health conditions and medication needs might change after enrolling in the plan.

If you face these types of difficult situations, you will need to consult a physician to determine whether your plan's formulary (list of covered drugs) includes an alternative, equally effective medication. If no alternative medications are appropriate, you may choose to request that your plan provider make an exception and cover a drug not included on your plan's formulary. Every plan will have a formal exceptions process that must be described in documents provided to you when you enroll in your Part D plan.

Show All Answers

1. What is Medicare Part D?
2. Who is eligible for Part D benefits?
3. Who will provide my prescription drug coverage?
4. Is participation required?
5. How do I know if I will have to pay a late enrollment penalty?
6. How do I sign up for a Medicare Part D plan?
7. When can I enroll in a Part D plan?
8. Can I change Part D Plans?
9. I'm married, do I apply with my spouse, or do I apply by myself?
10. Which drugs will Medicare Part D Plans cover?
11. Can a Part D Plan Provider change which drugs they cover?
12. What if I need a drug that is not covered by my Part D plan?
13. Where can I purchase prescription drugs if I enroll in Part D?
14. How much will Part D cost?
15. What can I expect to pay for my Part D Plan?
16. What is the difference between a co-pay and co-insurance?
17. Are the Part D Plans comprehensive or are there gaps in coverage?
18. What if I can not afford my Part D costs?
19. Will the rich pay more than the poor?
20. Why does it cost so much?
21. What if I am currently participating in a Medicare Savings Program such as SLMB, QMB, SLMB Plus, or a program that helps pay Medicare premiums?
22. What if I am currently receiving prescription drug coverage through SeniorCare?
23. If I currently receive prescription drug benefits through my Veterans Benefits, should I apply for Medicare Part D?