Guide to Medicare Part D: What If I Can't Get My Drug Because My Doctor Did Not Obtain Prior Authorization From My Part D Plan?

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This page is part of our Guide to Medicare Part D.

First, contact your doctor. Explain to your doctor that your Part D plan refused to cover your drug because he/she did not obtain prior authorization. Find out whether your doctor will prescribe a substitute drug that is on your Part D plan's formulary.

If your doctor believes that you must have the prescribed drug, then ask your doctor to contact your Part D plan to request an "Exception" and to explain why your drug is medically necessary.

NOTE: You have a RIGHT to request an Exception.

For questions or advice, contact
your nearest Kentucky legal services program.

Get more information about requesting an Exception.

Reviewed August 2009

This online guide was adapted with permission from Maine Legal Services for the Elderly. We extend our thanks to them.