For millions of people, the Medicare part D formulary is a hidden gem. It’s one of the most important parts of a Medicare part D plan for people, no matter if they are taking a lot of medications or not. It’s the part of a plan that helps people decide if they are going to pick a specific plan or not. As people think about their needs, the formulary is what they think of the most.
A Medicare part D formulary is the list of medications that are covered by the insurance provider. Most insurance providers pick a huge list of medications that have been given to them by the Centers of Medicare and Medicaid Services. This list is made of medications approved by several people including medical professionals and pharmacists. The medicines on the list include some of the most prescribed medicines on the market today and medicines for some of the more commonly complex ailments of today.
Why Isn’t Everything on the Formulary?
As people begin to enroll into a Medicare part D plan, they begin to wonder why all medications aren’t approved. While that is a great question, there are many medications that don’t meet the standards that CMS has listed. Medications that aren’t proven effective or cause more harm than good are less likely to be approved by CMS. Medications that are highly addictive or too expensive will be closely monitored because CMS doesn’t want to hurt more people than they will help.
Most people think a Medicare part D formulary should rival the formularies most companies have for their employees. It sounds good but even the most forgiving employer sponsored insurance plan doesn’t cover every medication on the market. There are limits that look slightly different than what CMS has issued.
What If a Medication Isn’t Listed?
As people think of their medication needs, they may be concerned that a company they enjoy doesn’t list their medications on the formulary. It’s something that has happened many times and CMS has wonderful plan in place to make sure a necessary medication is considered and possibly approved for each individual member.
When a medication isn’t on a Medicare part D formulary, members can request an exception be made. An exception is a request for a specific medication to be covered under the insurance. Anyone that wants to ask for an exception can call their Medicare part D provider and state they would like this to happen. Many providers will give their members the information they need to have their doctor work with their company to consider the request. When these requests are submitted with a doctor’s reasoning, a decision is normally made within 72 hours. Many people are surprised to find their Medicare part D plan is willing to work with them to get the medicines they need to treat an illness.
As people think about their needs, they realize how important their Medicare part D formulary really is. While some don’t need medications now, they may in the future. If there is a list of medications that are being taken very month, finding the best Medicare part D formulary is very important.