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.