What if a medication is currently paid for by Medicaid, but is not on any of the formularies for Medicare Part D?
If a plan does not cover a specific drug, it is required to utilize a minimum transition period of 30 days where the current drugs will be covered while the enrollee works with his or her doctor to find an alternative drug that is covered by the plan. If the doctor believes that the enrollee needs to take the current prescription drug and should not switch to another drug, the doctor can initiate an “exception” process to have the drug covered. If the plan refuses to give an exception, the plan’s decision can be appealed.
Related Questions
- If my prescription drugs are now paid for by my state Medicaid program, can my state make me join a certain Medicare drug plan?
- What if a medication is currently paid for by Medicaid, but is not on any of the formularies for Medicare Part D?
- What are the medication copayments for pharmacy claims paid by Indiana Medicaid?
