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Choose Your Plan

Step 2: Find out what to do if your medicine isn't covered.

Find out how to file an appeal if the PDP will not pay for the medicine you need. If the medicine you need is not on the formulary, you have the right to request a "formulary exception" from the PDP to ask that they pay for it anyway. You might not be told about your right to seek an exception when you are told that the PDP will not pay, so it is important to know how to file the request on your own. You'll need to ask your doctor to provide information to the PDP that explains why you need that specific medicine.

If the PDP refuses your request, you have a right to several more steps in an appeal process. The PDP must tell you about these steps if they deny your request for exception.