What to Do When No Medicare Part D Plan Covers Your Medication

1. Talk to Your Doctor First

Your first step should always be to talk with your prescribing doctor. Ask if there is a therapeutic alternative — a similar medication that’s covered by your plan and would work just as well.

Your doctor may be able to:

• Prescribe a different drug in the same class (for example, another brand or a generic that is covered).
• Adjust your dosage or formulation (for instance, two lower-dose pills instead of one high-dose pill, or a different strength that is covered).
• Switch to a combination medication that is covered by your plan.

Sometimes it’s as simple as using a covered dosage strength or formulation — your doctor can help identify the most cost-effective option that still works for you medically.

2. Request a Formulary Exception

If no covered alternative will work for you, your doctor can submit a Formulary Exception request to your Part D plan.

A formulary is your plan’s list of covered drugs. With a Formulary Exception, your doctor is asking your plan to:

• Cover a drug that is not on your plan’s formulary, or
• Make an exception to a restriction (like prior authorization, step therapy, or quantity limits).

Your doctor’s supporting statement must explain why:

• No covered medication would work as well for you, and/or
• The covered drugs would cause harmful side effects.

Your plan generally must respond within:

• 72 hours for a standard request, or
• 24 hours if your doctor says waiting could seriously harm your health.

If approved, you’ll usually get the medication at the copay level for the tier your plan assigns. If denied, you can still appeal.

3. Check Prescription Savings Programs

If the medication is truly excluded from all Part D plans, look at prescription savings programs such as:

• GoodRx
• SingleCare
• BuzzRx

You can use these coupons even if you’re on Medicare, but the purchase price will not count toward your Part D out-of-pocket limit.

Still, these programs can offer big discounts — and for some drugs, it may be cheaper to pay cash with a coupon than to fight for coverage.

4. Ask About Manufacturer Assistance Programs

Many pharmaceutical companies offer patient assistance programs that provide medications at low or no cost for people who meet income or insurance criteria.

Search your drug name plus “patient assistance program” or visit the manufacturer’s website. Programs like NeedyMeds.org and RxAssist.org can help you find them.

5. Explore State or Charitable Assistance

Some states and nonprofit organizations offer help with prescription costs — especially for chronic or high-cost conditions.

• Check with your State Health Insurance Assistance Program (SHIP).
• Ask your local pharmacy — many keep lists of disease-specific foundations that offer grants or copay support.

6. Compare Pharmacy Pricing

Even among retail pharmacies, cash prices can vary dramatically. HeyMOE automatically compares up to 20 local pharmacies, but you can also call around or check online tools.

Sometimes changing pharmacies saves more money than changing plans.

Bottom line:

If your medication isn’t covered by any Medicare Part D plan, don’t panic — it’s just the start of a checklist. Between your doctor, prescription savings programs, assistance foundations, and HeyMOE’s yearly reviews, you still have plenty of ways to keep your treatment affordable.