En español | Every calendar year, Part D plans can change many things — premiums, deductibles, copays and which drugs they cover. Each September, your plan is required to send you a letter, called the Annual Notice of Change, which provides details of changes it will make for the following year. This gives you the opportunity to use the annual open enrollment period (Oct. 15 to Dec. 7) to review your current coverage and switch to a different Part D plan if you want to. If you choose to switch, your new coverage begins Jan. 1.
During the year, a Part D plan may make changes to it formulary — dropping some from coverage or adding some it hasn’t covered before — according to Medicare regulations. If the change involves a drug you’re currently taking, the plan must take one of two actions:
However, if the plan has ceased to cover your drug because of a safety issue — for example, the national recall of a drug that has proved harmful in some way — the plan is not required to inform you.
It’s important to be aware that no Part D plan covers all drugs. But all plans are required to cover at least two drugs in each class of medications. A class means all the similar drugs that are used to treat the same medical condition. Also, each plan must cover all or nearly all the drugs used to alleviate six serious conditions: cancer, epilepsy, depression, psychoses, HIV/AIDS and organ transplants.
If your Part D plan does not cover (or stops covering) a drug that your doctor has prescribed as necessary for your health, you and your doctor can request the plan to make an exception to its rules and cover the drug in your case. Doctors are familiar with this process. The form your doctor needs to make the request can be downloaded from https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/downloads/PhysicianCoverageDeterminationRequestForm.pdf. The plan must make a decision within 72 hours of receiving the doctor’s request, or within 24 hours if the doctor says that the case is urgent.