Drug Not Covered...Try Using a Formulary Exception Request!

By Marc Manor

From time-to-time, I receive a call from a client who was prescribed a medicine that is not covered by their Medicare Prescription Drug Plan.  This can happen for any of a number of reasons but most of the time it is either because the drug is not on the plan's formulary; or it was not prescribed for use in a way that is approved by the Food and Drug Administration (FDA), or Medicare.  In most cases like this, you can request a "Formulary Exception Request".

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The Formulary Exception Request is usually a form that the prescription writer (doctor or other authorized professional) will fill out to request coverage on the drug that is prescribed.  In some cases there may be a generic or other brand name equivalent that can be prescribed; in this case, the insurance plan may have the doctor write the prescription for another covered drug, or request "step therapy" to transition the patient into the covered drug.  If there are no other alternatives, the insurance plan might make the "exception" and allow the drug to be covered.

Some drugs are very expensive and could be cost prohibitive without insurance coverage.  The Formulary Exception Request could be a real life saver in those situations.  If you find yourself in a situation where you do not have coverage, I recommend at least trying the Formulary Exception Request.  They are not guaranteed to be approved, but it could save hundreds or event thousands of dollars if they are.

So what if the Formulary Exception Request is not approved?  There are a number of reputable drug discount plans and other resources we can recommend to help ease some of the expense, including government programs.  Call us for a no-cost, no obligation consultation and we would be happy to work with you on a solution!

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Prescription Drug Readiness

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by Marc Manor

If you take prescription drugs, it would be wise to take inventory of your medicine cabinet and make sure you have adequate supplies to get you through the worst-case scenario. Most insurance plans offer mail-order options with online refill requests and some pharmacies are helping with delivery as well. A 90-day supply can be requested on some prescriptions. If you take meds that have quantity limits you can request your insurance plan and pharmacy to waive those requirements during the crisis.

Doing things like cutting pills and skipping days may be harmful to your health and should be avoided if at all possible. People taking drugs for diabetes are especially at risk.

If your prescriptions are expensive, call us at 904-222-0698 and we can help direct you to discount prescription drug or government programs that may be able to help.

Here is an article from "EverydayHealth.com" that has more helpful information:

https://www.everydayhealth.com/infectious-diseases/coronavirus-and-prescription-medications-should-you-stock-up/

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Medicare Prescription Drug Growing Pains 2020

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Have a new Prescription Drug Plan for 2020? If so you may be experiencing some "growing pains" associated with moving to a new plan. Plans sometimes have different formularies and there are other requirements such as pre-authorization (PA) and Quantity Limits (QL) that may be required that cause delays on processing your prescriptions. Be sure to put your first fill/refill in with a least 5 working days in advance of your need to allow these requirements to process. Call us at 904-222-0698 or email marc@marcmanor.com if you have questions!

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.