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Use Your Plan: Troubleshooting
Problem #6: Prior approval is required.
Sometimes a pharmacist can only fill a prescription if your health care provider has already gotten approval from your PDP. This is called a prior authorization, and it means that your PDP must approve a particular medicine before the plan will pay for you to have it. If this is the problem, you can get approval if you or the pharmacist contacts the health care provider who prescribed the medicine and the health care provider submits the necessary information to the PDP.
Download a form your pharmacist can use when sending information to your health care provider to make sure he/she has all the information he/she needs to request prior authorization from your plan.
Download a form your health care provider can use when sending information to your plan to make sure the plan has all the information it needs to consider your prior authorization request.
Go to a list of Medicare Prescription Drug Plans by state, including plan-specific information on how to get forms and request prior authorization and exceptions.
| Problem 1
|
No Card: You have enrolled in a new Medicare drug plan but don't yet have a pharmacy benefit ID card to take with you when you fill your first prescription. |
| Problem 2
|
Not Covered: Your prescription drug plan (PDP) does not pay for the medicine you were prescribed. |
| Problem 3
|
Incorrect ID Information: The information the pharmacy has about your prescription drug plan (PDP) doesn't match what is on your pharmacy benefit ID card. |
| Problem 4
|
Timing: It's too soon to refill the prescription. |
| Problem 5
|
Drug Interactions: The medicine was flagged because it may react badly with another medication you're taking or because of another medical condition you have. |
| Problem 6
|
Prior Approval Required: Prior authorization is required. |
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