Requesting a Drug Waiver on a Medicare Part D Plan
Question: Why is it that insurance companies have the last say of all meds that we take even if the doctor’s order means that I cannot take a certain med because it causes real severe allergies that can make it more severe for my COPD? My doctor has made a great effort to help me and the insurance company won't listen. Is it because we are old and they don’t care of our quality of what little life we have left?
Answer: Insurance companies participating in Medicare Part D are required to cover drugs in all categories but not every drug available in a category. Generics are used where available. There is always an exception and there is a process for requesting an exception waiver. I have had several clients whose doctors have documented that my clients are unable to take a particular drug and must take a certain other drug, and of course the reason why. Their waiver has been granted. Perhaps your doctor is not providing the documentation required. Has your agent contacted the plan on your behalf? If your case is a documented need and not just a preference you should be able in most cases to get the drug your doctor is ordering. If you've tried all these things, you might want to consider switching plans when annual enrollment comes around (Oct 15-Dec 7, 2011). Some plans are more tightly managed and some are just easier to work with than others.