Guide to Medicare Part D: What If My Part D Plan Removes My Drug From Its Formulary?

Printer-friendly versionPrinter-friendly version
This page is part of our Guide to Medicare Part D.

Your Part D plan must provide written notice to you at least 60 days prior to the effective date of the change in its formulary.

If your Part D plan fails to provide you with written notice of a change in its formulary, it must provide you with a 60-day supply of your drug.

NOTE: Your Part D plan cannot change its formulary from November 15 - March 3 of each year.

If your Part D plan fails to provide you with written notice of a change in its formulary, and refuses to provide you with a 60-day supply of your drug, contact your nearest Kentucky legal services program.

If you receive notice from your Part D plan, or otherwise find out about formulary change that affects you, contact your doctor.

Explain to your doctor that your drug is no longer on your Part D plan's formulary. 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.