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Table of Contents
Getting Started - The Basics
About Enrolling
Costs and Coverage
Problems Getting Your Drugs Under Your Plan
Other Common Problems / Changing Plans
Information for Medicare Providers
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Sample Physician Statements
By clicking on the icons below, you can download a Sample Statement in either
PDF or Word format (for editing) for situations when:
- The Part D plan determines that the drug is not medically necessary.
By clicking on the icons below, you can download a Sample Statement in either
PDF or Word format (for editing) for situations when:
- The drug is not on the Part D plan's formulary
- Prior authorization was not obtained from the Part D plan
- The prescribed form (liquid versus pill), or type (generic versus brand)
of drug, is not on the Part D plan's formulary
- The method of administration or dosage in not on the Part D plan's formulary
- The drug was removed from the formulary
By clicking on the icons below, you can download a Sample Statement in either
PDF or Word format (for editing) for situations when:
- The patient cannot afford the drug
| NOTE:
A plan is not required to cover a non-preferred drug at the generic cost-sharing
level if the plan maintains a separate tier dedicated to generic drugs. |
| NOTE:
A Plan may exempt very high cost or unique drugs, such as genomic or biotech
products, from the cost-sharing Exception process if it maintains a formulary
tier specific to such very high cost or unique drugs |
| NOTE: An enrollee
may not request a cost-sharing Exception for a non-formulary drug that was
previously approved for an Exception. |
For questions or advice, contact
Legal Services for the Elderly at 1-800-750-5353
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