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Choose Your Plan

Step 4. Find out if the PDP has to pre-approve certain drugs before you can fill the prescription.

Some PDPs will require your doctor to have prior authorization for some medicines before the plan will pay for them. That means your physician or pharmacist must call for permission to prescribe these medications. Some PDPs also require you to try a less expensive medicine before they will pay for the one your doctor might otherwise recommend. This is called step therapy.

If you need a certain medication for a valid medical reason, you may be able to get it covered by filing a request for exception. If you can't wait for the exception process to finish, you may need to pay for the medicine yourself and then file a request for exception so that you can be paid back by the plan.