Getting The Most Out of Medicare's Drug Plans

Federal Citizen Information Center

Staying healthy as you age means eating right, exercising, and, often, taking medicine. If you have a Medicare prescription drug plan, many of your medicines are probably covered, but not all of them. When you need to take a drug your Medicare plan doesn’t pay for, turn to Using Your Medicare Drug Plan: What to Do if Your Medicine Isn’t Covered, a free booklet from YourPharmacyBenefit.org and the Federal Citizen Information Center.

You may feel like you have nowhere to turn if you can’t afford to get a prescription filled without help from your drug plan. But before you start worrying, read What to Do If Your Medicine Isn't Covered and look at all your options.

First, ask why your plan didn’t pay for the medicine. You may need to meet your deductible amount before your plan will cover the medicine. Next, see if the prescribed medicine is on your plan’s formulary (the list of medicines your plan covers). If it’s not, you may have to ask your plan to cover the medicine using a "prior authorization" or an "exception." If the medicine is covered by your plan, you may only be able to get a limited amount each month or year. This booklet has tips for ways to handle each situation to help you get the medicine you need.

If your drug plan denies you coverage, you may need to begin an appeal process to get your medicine covered. There are three levels of appeal, and What to Do outlines the steps to take at each level. It’s important to use the specific terms Medicare uses for each step in the process, and What to Do defines those words, tells you what information to include with each appeal, the amount of time you have, and what to expect back from Medicare. It also has a sample appeal letter you can use to get started.

Getting the right medicine is important so you can maintain your health. Knowing how to get coverage for those medicines is easier with this free booklet. You can download the booklet in PDF format by clicking here. If you would like to order a printed copy of the booklet, you can:

• Send your name and address to What to Do, Pueblo, Colorado 81009.
• Visit the Federal Citizen Information Center to place your order online.
• Call toll-free 1 (888) 878-3256, weekdays 8 a.m. to 8 p.m. Eastern Time and ask for What to Do.

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