MY PRESCRIPTION WAS NOT COVERED BY MEDICARE.
WHAT DO I DO NOW?
Medicare Prescription Drug Coverage and Your Rights
You have the right to get a written explanation from your Medicare
drug plan if:
your doctor or pharmacist tells you that your Medicare drug plan will not
cover a prescription drug in the amount or form prescribed by your doctor
you are asked to pay a different cost-sharing amount than you think you
are required to pay for a prescription drug
The Medicare drug plan’s written explanation will give you the specific
reasons why the prescription drug is not covered and will explain how to request an appeal if you disagree with the drug plan’s
decision.
You also have the right to ask your Medicare drug plan for an exception
if:
you believe you need a drug that is not on your drug plan’s list
of covered drugs. The list of covered drugs is called a "formulary;" or
you believe you should get a drug you need at a lower cost-sharing amount.
What you need to do:
contact your Medicare drug plan to ask for a written explanation about
why a prescription is not covered or to ask for an exception if you believe you need a drug that is not on your drug plan’s
formulary or believe you should get a drug you need at a lower cost-sharing amount
Refer to the benefits booklet you received from your Medicare drug plan
or call
1-800-MEDICARE to find out how to contact your drug plan when you contact
your Medicare drug plan, be ready to tell them:
1. the prescription drug(s) that you believe you need
2. the name of the pharmacy or physician who told you that the prescription
drug(s)is not covered
3. the date you were told that the prescription drug(s) is not covered
