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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).