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Medicare Part D: What Drugs Are Covered - The Formulary

Exceptions For A Lower Copayment And Restrictions

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You can request an exception to get a lower copayment for a drug which is already included in your Plan's Formulary. Generally this means moving the drug to a lower tier than the one assigned by the Plan.

Note that if you requested an exception to get the drug covered by your Plan, you cannot file a second exception to get the copayment lowered.

Once a copayment is set, the Plan must continue refills at that level for the rest of the calendar year if the doctor continues to prescribe the drug. The Plan can revisit the copayment question each year. You plan must inform you of its policy for the following year in its Annual Notice of Change.

Of course, you have the right to change plans each year as well.


You can also request an exception for other coverage restrictions. For example, you can request that dosage limitations be revised, or step therapy be skipped.

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