I switched to a new Part D plan and now half my meds require prior authorization. Why didn't anyone warn me this could happen?

Question

Yasmery Vargas · Accepted Answer

When transitioning from a prescription drug plan to a different prescription drug plan, It is extremely important to sit down and review the formulary associated with the plan to make sure your medications are covered. It is also a good practice to consult with your doctors on what insurance they take and/or support for ease of transition. Look out for your Explanation of Benefits and Annual Notice of change later in the year. These documents are made to inform you about what you have and what's to be expected and if there are any changes for the new year. While this may not answer, why there was no warning, hopefully this will help avoid this from happening again.

Answered by Yasmery Vargas on April 15, 2025

Agent Licensed in PA

Answered by Yasmery Vargas Medicare Insurance Agent

Dutch VanHoesen · Answer

This information is required to be in the enrollment materials. If you enrolled yourself you're on your own. If you used an agent or a broker they are required to give you this information. This is precisely the reason why you should use a broker who's not affiliated with any carrier and who doesn't cost you anything to use their expert recommendations.

Answered by Dutch VanHoesen on May 29, 2025

Broker Licensed in FL

Answered by Dutch VanHoesen Medicare Insurance Agent

Randall Taylor · Answer

Part D plans tend to change every year. You absolutely must review your Part D plan every Annual Election Period (AEP) which is always October 15 - December 7. After that, no changes can be made until the next AEP. Your Medicare Specialist can help you with reviewing your plan for the coming year. All Part D plans are in effect from January 1 - December 31.

Answered by Randall Taylor on April 7, 2025

Broker Licensed in TX, MI & WI

Answered by Randall Taylor Medicare Insurance Agent

Jon Kelderman · Answer

If you use a good local agent they will help you check your plan to make sure it works with your pharmacy and your prescriptions. Sorry you had a bad experience. Shiip counselors can also help.

Morris Johnson · Answer

I can not tell you why someone did not let you know. But you do have the right to contact medicare and let them know and see if you can change your plan under certain situations.

Timothy Brown · Answer

Sometimes that can be difficult to assess but keep in mind that not all prescriptions are listed in the same tier from plan to plan and some require prior authorization based on that category.

Barbara Barnes, CMIP® · Answer

Did you use a licensed Medicare insurance agent to help you make this change? Did you research your plan options on Medcare.gov? In either case, disclosure should have been made of the medications that require pre-authorization. Did you read all of the plan information and disclosures? 

When you switch insurance companies for your Medicare Advantage or Medicare Part D plan, it is important to acknowledge that you are leaving one company where you perhaps had prior-authorizations already in place or where prior-authorizations were not required, to move to a completely different insurance company with entirely different requirements. The new company will have a different medication formulary and may require different prior-authorizations with entirely different requirements for those authorizations. Step therapy May now be required, or they may require you try different medications or procedures before they will authorize what you want. You cannot make these changes lightly if you are in treatment for a chronic condition. This is another reason to use a licensed and experienced Medicare insurance agent to help you with these potentially treatment-delaying decisions. If you’re going to do this on your own, you need to read and understand everything about the new plan before you make any changes because once you are locked-in to a plan, you likely cannot move again until the next enrollment period.

Dana Dane · Answer

Your agent should have shown you the details of your prescription coverage at the time of enrollment, including but not limited to prior authorization, quantity limits and step therapy. Contact your doctor about prior authorization for those particular medications and they will send prior authorization to your prescription company. Please contact your agent for more information.

Answered by Dana Dane on April 10, 2025

Agent Licensed in OR, AZ, CA & 6 other states

Answered by Dana Dane Medicare Insurance Agent

Daintee Hurst Dietz · Answer

Your agent should have given you the details of the plan to know you will need (possibly) authorizations.

Rene Casanova · Answer

Who ever helped you choose your PDP plan should have told you there are three components all PDP plans must contain. One is Step Therapy, the second is Quantity Limits and the third is Prior Authorization. It’s a cost savings measure and should not be thought of it as penalty of Medicare Beneficiaries.

Answered by Rene Casanova on July 14, 2025

Broker Licensed in TX

Answered by Rene Casanova Medicare Insurance Agent

Steve Brauer · Answer

When your Independent Broker strategized your new Part D plan, that should have been part of the discussion. Oh...you didn't use an Independent Broker...that may be part of the problem

Deborah Webster · Answer

This information is in your evidence of coverage. If you worked with a broker to sign up for your part D plan, the agent should have covered that when you signed up. This information is also available on Medicare.gov

Answered by Deborah Webster on May 15, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Mary Salmon · Answer

It is extremely important to do an annual review of your prescription drug plan with a reputable licensed agent. The agent should be asking for an updated list of all medications and your preferred pharmacy. By checking your medications against the available plans in your area and their formularies, you can choose a plan that best fits your needs and keeps the prescription drug costs to a minimum.

Answered by Mary Salmon on April 16, 2025

Broker Licensed in TX & OK

Answered by Mary Salmon Medicare Insurance Agent

David Christian · Answer

It will depend on how you switched. If you spoke with an agent or broker or the new PDP plan carrier before you switched, they should have went through your medication list with you and verified what tier they are on and if they were going to need prior authorization. If you did it yourself, then you would have had to do the research with the carriers information they provide in the formulary either online, over the phone or by having them mail you the formulary previous to you enrolling.

Answered by David Christian on April 10, 2025

Broker Licensed in CA & TX

Answered by David Christian Medicare Insurance Agent

Kelly Linster · Answer

Prior authorizations are a function of the medicines being taken. This issue would happen with most Part D plans. The beauty is you’re not locked in forever. We can help you evaluate a new plan in the fall.

Answered by Kelly Linster on April 15, 2025

Agent Licensed in ND, AZ, CO, IA & SD

Answered by Kelly Linster Medicare Insurance Agent

Daniel Keane · Answer

Not all plans indicate whether prior authorization is required. You should talk to the Dr prescribing the medication and they may be able to challenge the requirement.

Tonya Mowan · Answer

When you switched to a new Medicare Part D plan, the new plan has different rules for your medications. That’s why some of your drugs now need prior authorization—which means the plan wants your doctor to explain why you need the medication before they’ll pay for it.

No one may have warned you because:

Each plan has its own list of covered drugs and rules, and

These details aren't always clear unless someone checks your exact medications before you switch.

What you can do now:
Ask your doctor to send in the prior authorization.

Call your plan to see if there’s a similar drug that doesn’t need approval.

Next time you switch plans during an enrollment period, have someone review your full medication list first.

Craig Bodner · Answer

A good broker understands that it is critical to thoroughly review all aspects of medication coverage before enrolling a client in a plan. Clients should be aware of any prior authorization requirments, quantity limits, and "step therapy" requirements related to their drug coverage before enrollment, not after.

Answered by Craig Bodner on April 11, 2025

Broker Licensed in AZ, CA, CT & 8 other states

Answered by Craig Bodner Medicare Insurance Agent

I switched to a new Part D plan and now half my meds require prior authorization. Why didn't anyone warn me this could happen?

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I switched to a new Part D plan and now half my meds require prior authorization. Why didn't anyone warn me this could happen?

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