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.

Dear Politician: Just What Is “Medicare For All”?

By Marc Manor

As we prepare ourselves for the onslaught of political rhetoric associated with the 2020 presidential and Congressional campaigns, we have all heard the term “Medicare for All” as a means to fix our healthcare system.  I must admit, the more I hear the talk about Medicare for All, the more questions I have.  As an insurance agent who works to place Medicare beneficiaries into appropriate coverage, I can tell you that most people I talk to do not really understand our current Medicare system when they become eligible.  Based on much of what I have heard from politicians, it seems to me they also don’t understand Medicare.

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I should disclose, I do have some personal interest in how Medicare for All would come to be.  Obviously, if commercial insurance companies were cut out your proposed system, me and thousands (if not millions) of people would have to find a new livelihood.  Having said that, I would support any functional system of healthcare over what we have now for people not eligible for Medicare.

Tiers of Sadness...Tiers of Joy: Strategies for Medicare Prescription Drug Plans

By Marc Manor

The plight of those Medicare beneficiaries that take one or more high cost prescription drugs can be challenging; and as with anything in the Medicare Advantage or Prescription Drug Plan (PDP) world, the landscape can be foggy and difficult to sift through to find affordable solutions. Sometimes, it may be possible to save a few dollars if we take the time to research a few variables. Prescription drugs are categorized in “tiers” that relate to the coverage level according to the benefit schedule of each PDP. As a rule, the higher the tier, the more expensive the drugs will be for the consumer (and the plan). I say “as a rule,” because there are some exceptions to the rule if one digs deep enough and searches through several variables.

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Generic vs. Name Brand Drugs

Preparing for Annual Medicare and Healthcare Insurance Renewals

By Marc Manor

With Medicare Annual Enrollment Period (AEP) and Healthcare Open Enrollment right around the corner, I thought annual renewals would be a timely and appropriate subject for this week’s blog.  Many of our clients want to know what this means to them. People looking for healthcare or a change in providers want to know when and how they can make those choices when the time comes.  Because AEP and Open Enrollment  coincide with the holiday and shopping season, it’s important to have a plan before the throws of shopping and family consume us. Here are some questions to consider:

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Is my current Medicare or healthcare plan the right fit?

If your Medicare or healthcare plan is providing you with all the coverage you need, and it fits your budget, then you should likely stay with where you are.  Your provider probably already has the information they need and you have become familiar with the benefit schedule, co-payments etc.  If this is the case, you may want to just stay put and roll into next year with the same plan. 

I got a letter about “renewal” what does this mean?