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3 Tips for When the Pharmacy Says No To Your Prescription Drug

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Tags: drug costs and seniors, Medicare, Medicare Part D

What do you do when the pharmacy says your Medicare drug plan won’t cover your prescription? 

  • Your ask a few questions to try to understand what’s going on
  • You walk away from the counter furious, confused and embarrassed without the prescription you need.

It’s happening to more and more people with Medicare prescription drug coverage as the plans try to control costs by putting restrictions on more drugs.  The Medicare Rights Center told Kiplinger’s that they are seeing an increase in calls to their national helpline.  Joe Baker, the Center's president said "The problem of pharmacy denials and people being confused by Part D prescription-drug coverage is a growing trend.”

The Kaiser Family Foundation says that restrictions applied to about 39% of the Medicare drug plan formularies (list of drugs covered by the plan) in 2015.

As a service to its Medicare customers, Longevity Alliance helps their clients sort through the issues and options to get the prescription drug coverage they need.  Longevity Alliance has two new publications to help consumers with drug plan issues:

Guide to Drug Plan Exceptions explains the different reasons for denial and how to appeal a drug plan decision.

Frequently Experienced Problems with Medicare Drug Plans identifies common problems and solutions when you find that your drug plan isn’t working the way you thought it would.

There is often a solution that will solve the problem – or at least make it less painful – until you can switch plans during the Medicare Annual Enrollment Period (Oct. 15- Dec. 7).

The use of restrictions by insurance companies to control costs is one that experts say will continue. Use these 3 tips to get the most out of your Medicare Drug Plan.

  1. Know your rights to appeal.
  2. Explain your problem to your doctor and ask for options that might be covered better by YOUR plan. Your doctor doesn’t know your plan specifics.
  3. Make sure that each year during the annual enrollment period you shop and compare Medicare drug plans so that you get a plan that is the best match to your needs the next year. Remember, drug plans change every year – including how the plan covers your prescription (not just the cost).  
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