Guide to Medicare Part D: What If I Can't Get My Drug Because My Doctor Did Not Obtain Prior Authorization From My Part D Plan?

 

First, contact your doctor.

Explain to your doctor that your Part D plan refused to cover your drug because he/she did not obtain prior authorization. Find out whether your doctor will prescribe a substitute drug that is on your Part D plan's formulary.

If your doctor believes that you must have the prescribed drug, then ask your doctor to contact your Part D plan to request an "Exception" and to explain why your drug is medically necessary.

NOTE: You have a RIGHT to request an Exception. For questions or advice, contact your nearest Kentucky legal services program.

Get more information about requesting an Exception.