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?
Answered by 16 licensed agents
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.
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.
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.
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.
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.
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.
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.
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
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.
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
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.
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.
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.
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.
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.
