Presumably, if you have a Medicare Part D Plan or a Medicare Advantage Plan (Part C) that includes Part D drug coverage, you looked at its formulary before you made the decision to enroll in the plan. Perhaps since then, however, you have developed a need for another medication which is not covered by your health plan. What can you do in this circumstance? You have several options. Consult Your Doctor The first step is to consult your doctor. Your health plan's formulary is the list of drugs it will cover. If your plan does not cover the medication you need, perhaps there is another similar drug in the formulary, which your doctor should know about. In some cases there are other factors involved: The drug you need may require prior authorization. This means that your doctor must notify the plan that for you this drug is medically necessary. Your plan may require step therapy. This means that before your more expensive drug is authorized, you need to try a less-expensive one or … [Read more...]