In most cases, 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.
In a few situations, for example if the FDA suddenly raises major safety issues,
the Plan can remove a drug of its Formulary without providing 60 days notice.
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:
Legal Services for the Elderly, Medicare Part D Appeals
Unit
1-877-774-7772
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 the Medicare Part D Appeals Unit
of Legal Services for the Elderly at 1-877-774-7772.
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