Prescription drugs available through Medicare Part D prescription drug coverage vary from plan to plan. Each plan has its own formulary, which is a list of prescription drugs the plan provides. Plan holders can request an exception for specific drugs they need that are not covered by the plan.
Medicare Part D plans must provide two types of drugs used to treat most medical conditions. Typically drugs are divided into tiers, with drugs in lower tiers less expensive than drugs in higher tiers. Copayments and percentages patients have to pay are often most favorable for inexpensive generic drugs, higher for brand-name drugs and most expensive for specialty drugs. Plans sometimes change the drugs they cover during the mid-year, although they are required to provide a 60-day warning to patients before they remove drugs from their formularies.
To request a drug a Medicare Part D plan doesn't normally cover, patients must request an exception by submitting a coverage determination form along with a statement from their doctor explaining why the particular drug is needed. Within 72 hours of receiving the request, or 24 hours in an emergency, plan administrators must respond. If the plan refuses the request, patients have the right to protest through several levels of appeal.