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Fighting a Drug Coverage Denial

These workarounds should help curb the Rx stalemate.

Question: My Medicare Part D plan is not covering a drug that my doctor prescribed. What can I do? - D.W., Dallas

Answer: Find out why the drug wasn’t covered. Your doctor may just need to fill out a prior authorization form each year explaining why you need the drug. If insurance still doesn’t cover it, ask your pharmacist for the cash price, which may be less with coupons or discount programs found through GoodRx.

Alternatively, ask your doctor if you can switch to another drug that is covered by your insurance. Many plans have online tools listing these “therapeutic alternatives” and showing how much you’d pay.

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If that doesn’t work, your doctor can request an exception or file an appeal (see medicare.gov/appeals). Your pharmacist and State Health Insurance Assistance Program can help (see shiptacenter.org).

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