What if my Medicare Part D plan removes my drug from its formulary?

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In most cases, your Medicare Part D plan must provide written notice to you at least 60 days prior to the effective date of the change in its formulary. In a few situations, for example if the FDA suddenly raises major safety issues, the Plan can remove a drug of its Formulary without providing 60 days notice.

NOTE: Your Medicare Part D plan cannot change its formulary from November 15- March 3 of each year.

If your Medicare Part D plan fails to provide you with written notice of a change in its formulary, and refuses to provide you with a 60-day supply of your drug, contact:

Legal Services for the Elderly, Medicare Part D Appeals Unit
1-877-774-7772

If you receive notice from your Medicare Part D plan, or otherwise find out about formulary change that affects you, contact your doctor.

Explain to your doctor that your drug is no longer on your Medicare Part D plan's formulary. Find out whether your doctor will prescribe a substitute drug that is on your Medicare Part D plan's formulary.

If your doctor believes that you must have the prescribed drug, then ask your doctor to contact your Medicare Part D plan to request an "Exception" and to explain why your drug is medically necessary.

NOTE: You have a RIGHT to request an Exception.

For questions or advice,
contact the Medicare Part D Appeals Unit of
Legal Services for the Elderly at
1-877-774-7772
.

Get more information about requesting an Exception.