Discovering that one of your prescriptions is not covered by your 2025 Medicare drug plan can be frustrating. Fortunately, there are options available to ensure you continue receiving your necessary medication. Here’s what you need to know:
If your Medicare drug plan no longer covers your medication, here’s what you can do:
Request a Transition Fill
- You may qualify for a one-time, 30-day supply during the first 90 days of your plan.
- Call the Member Services number on the back of your ID card to request it.
- Cost: Expect to pay 25% to 50% of the retail price, similar to an approved formulary exception.
- Who Qualifies? Transition fills are for medications you were already using but are no longer covered. They are not for new prescriptions started in 2025.
File a Formulary Exception
- If you need long-term coverage, your doctor can request an exception with medical justification.
- Restrictions: Some drugs, such as weight-loss medications, are not covered under Medicare Part D and may not qualify for a transition fill.
Next Steps
- Check with your doctor for possible alternatives.
- Review your plan’s formulary to explore other options.
Final Tips
- Check your Medicare plan’s formulary exception cost-sharing tier to understand your potential out-of-pocket costs.
- Be aware that opioids and controlled drugs may have additional restrictions.
- Understanding these options can help you navigate prescription coverage changes with confidence.
If you need assistance, Griset Medicare Solutions is ready to help you navigate your Medicare options and find the best solution for your healthcare needs.