What if my doctor prescribed a dosage that is not covered by my Medicare Part D plan?
First, contact your doctor.
Explain to your doctor that your Medicare Part D plan refused to cover your drug because the prescribed dosage is higher than the plan will normally cover. Find out whether your doctor will prescribe a substitute drug or a different dosage that is on your Medicare Part D plan's formulary.
If your doctor believes that you must have the prescribed dosage, then ask your doctor to contact your Medicare Part D plan to request an "Exception"(Coverage Determination) and to explain why the dosage is medically necessary.
NOTE: You have a RIGHT to request an Exception (Coverage Determination).
For questions or advice,
contact the Medicare Part D Unit at
Legal Services for the Elderly at
Get more information about requesting an Exception (Coverage Determination).