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 (opens in new tab).

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 (opens in new tab)). Your pharmacist and State Health Insurance Assistance Program can help (see shiptacenter.org (opens in new tab)).

Kimberly Lankford
Contributing Editor, Kiplinger's Personal Finance

As the "Ask Kim" columnist for Kiplinger's Personal Finance, Lankford receives hundreds of personal finance questions from readers every month. She is the author of Rescue Your Financial Life (McGraw-Hill, 2003), The Insurance Maze: How You Can Save Money on Insurance -- and Still Get the Coverage You Need (Kaplan, 2006), Kiplinger's Ask Kim for Money Smart Solutions (Kaplan, 2007) and The Kiplinger/BBB Personal Finance Guide for Military Families. She is frequently featured as a financial expert on television and radio, including NBC's Today Show, CNN, CNBC and National Public Radio.