What should Mr. Zachow do to obtain coverage for his Part D drug that is not on his plan's formulary?

To obtain coverage for a Part D drug that is not on his plan's formulary, Mr. Zachow should request a formulary exception via the standardized form. This process allows beneficiaries to appeal and request coverage for a medication that their current plan does not list as covered. The formulary exception request must provide justification, typically involving a statement from a healthcare provider that explains why the non-formulary drug is medically necessary for the patient.

Utilizing the standardized form streamlines the process, ensuring that the request is evaluated properly according to the plan's guidelines. Plans are required to inform the beneficiary of their decision regarding the exception request within a specific timeframe. This approach is typically the most practical and effective way for individuals to seek coverage for necessary medications not listed in their formulary, enabling them access to the drugs they need for their proper treatment and health management.