My drug plan says it doesn’t cover my medication. Is there anything I can do?

Yes. Ask the plan why the prescription was rejected, then contact the clinician who prescribes it. The next step depends on whether the drug is missing from the plan’s list or the plan needs approval, additional information, or a different treatment tried first.

You or your prescriber can request a formulary exception, asking the plan to cover a Part D drug it does not normally cover. Your prescriber must explain why the covered alternatives would not work as well or could cause harm. Approval is not guaranteed.

For a request to receive a drug, the plan generally has 72 hours to decide once it receives the prescriber’s supporting statement. If waiting could seriously harm your health, ask about an expedited request; that decision is due within 24 hours after the supporting statement arrives. These are exception-request deadlines, not the deadlines for every later appeal.

If the plan denies the request, use the appeal instructions in its decision letter. Don’t stop or change treatment on your own while resolving coverage.