by Barbara Nevins Taylor
You may ask, “Why should I review Medicare Part D?” You have the Part D prescription drug plan and it seems like a lot of trouble to take a second look. Here’s the problem: your Medicare Part D insurer changes the drugs it covers every year. And if they covered your medication this year, they may not do it in 2018. So when you go to fill your prescription, your pharmacist may give you a “drug-not-covered” notification.
You have a limited window to see if your medication will be covered and, if not, to change your Medicare Part D plan to find an insurer who covers your drug or drugs without penalty if your present insurer doesn’t offer the same coverage.
The open enrollment period runs from October 15, 2017 to December 7, 2017. This year, the Trump Administration changed the rules to make it easier for the insurers, but that may make it more difficult for you.
In the past, insurers routinely sent out pamphlets listing all the drugs they plan to cover in what they call their “formulary.” This year some insurers didn’t do that. I was surprised that Express Scripts didn’t send one to me this year, and I called.
The person on the phone said they weren’t mailing them automatically anymore. But I could request one, which I did.
But what about everyone else who uses Express Scripts for Medicare Plan D? Ellen Drazin, a public relations executive at Express Scripts, told ConsumerMojo.com in an email, “This year, CMS made a guidance change that allowed plans to send a formulary notice instead of the full formulary. This reduces printing and shipping costs for plans, which then results in savings for Medicare enrollees. We do mail printed formularies upon request via phone, website or email.”
That rule change means you may need to request the list of covered drugs or go online, as Express Scripts suggested that I do. But it makes money sense for you to review your Part D plan and switch if the insurer doesn’t cover what you need.
You can appeal and the insurer may relent, but it will require a doctor letter and follow-ups from your physician. We explain how to do that here.