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 8 licensed agents

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
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
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
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

Answered by Steve Brauer on April 17, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent
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
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
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
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

Tags: Medicare Part D

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