Check the Formulary Before Getting a Prescription Filled
All Medicare Part D plans use a formulary -- a list of drugs covered by the Part D plan you selected. You should check the formulary for your Part D plan before getting a prescription filled to make sure the drug is covered by the plan.
All generic drugs are covered even if they are not listed on the formulary, except the drugs not covered by Medicare.
You can get up to a 90-day supply for most covered drugs, but specialty drugs are limited to a 30-day supply.
Some drugs require prior authorization or step therapy, and some drugs have quantity limits. You can review the Plan's criteria for requiring prior authorizations for certain drugs (see link on the left side of your screen).
The formulary may change throughout the year. Each formulary is reviewed and updated on a regular basis by medical and pharmacy professionals. Changes to the formulary are listed on your Explanation of Benefits (EOB) at least 60 days in advance. Or, you can review the Notice of Formulary Updates (also on the left side of your screen).
NRECA has two formularies for its Part D plans (also on the left side of your screen):
Please read the introduction to the formulary. It explains
- how to use the formulary
- what drugs are excluded by Medicare
- what to do if your drug requires prior authorization or step therapy, may be covered by Part B or Part D, or has quantity limits
- what to do if the formulary changes
- what to do if a drug you are taking is no longer on the formulary
- what to do if you disagree with a drug coverage or payment decision
Remember to use a network retail pharmacy or the mail order pharmacy to be covered by the plan, except in an emergency.
If you have any questions, call Customer Care.