New for Consumers

Release Date: December 2007

GETTING THE MOST OUT OF MEDICARE’S
DRUG PLANS

Staying healthy as you age means eating right, exercising, and, often, taking medicine. If you have a Medicare prescription drug plan, many of your medicines are probably covered, but not all of them. When you need to take a drug your Medicare plan doesn’t pay for, turn to Using Your Medicare Drug Plan: What to Do if Your Medicine Isn’t Covered, a free booklet from YourPharmacyBenefit.org and the Federal Citizen Information Center.

You may feel like you have nowhere to turn if you can’t afford to get a prescription filled without help from your drug plan. But before you start worrying, read What to Do and look at all your options. First, ask why your plan didn’t pay for the medicine. You may need to meet your deductible amount before your plan will cover the medicine. Next, see if the prescribed medicine is on your plan’s formulary (the list of medicines your plan covers). If it’s not, you may have to ask your plan to cover the medicine using a “prior authorization” or an “exception.” What to Do can guide you through the process. If the medicine is covered by your plan, you may only be able to get a limited amount each month or year. What to Do has tips for ways to handle each situation to help you get the medicine you need.

If your drug plan denies you coverage, you may need to begin an appeal process to get your medicine covered. There are three levels of appeal, and What to Do outlines the steps to take at each level. It’s important to use the specific terms Medicare uses for each step in the process, and What to Do defines those words, tells you what information to include with each appeal, the amount of time you have, and what to expect back from Medicare. It also has a sample appeal letter you can use to get started.

Getting the right medicine is important so you can maintain your health. Knowing how to get coverage for those medicines is easier with this free booklet. There are three easy ways to order:

  • Send your name and address to What to Do, Pueblo, Colorado 81009.

  • Visit www.pueblo.gsa.gov/rc/n71whattodo.htm to place your order online or to read or print this and hundreds of other Federal publications for free.

  • Call toll-free 1 (888) 8 PUEBLO. That’s 1 (888) 878-3256, weekdays 8 a.m. to 8 p.m. Eastern Time and ask for What to Do.

Get even more information and take advantage of online government resources at www.USA.gov and www.GobiernoUSA.gov—your official English and Spanish web portals to the Federal government.

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  • Please check with Rebecca Fulcher if you plan to use this release after March 1, 2008.
  • To receive New for Consumers releases by e-mail, send a request to rebecca.fulcher(at)gsa.gov or call (202) 501-1794.

GSA #2859

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