What can Mr. Zachow do regarding a drug that is not on his Part D plan’s formulary?

Mr. Zachow has the right to request a formulary exception for the drug that is not on his Part D plan's formulary. This process allows individuals to advocate for their specific medication needs when a prescribed drug is not listed in their plan's covered medications.

A formulary exception can help ensure that the patient can access necessary treatments despite the limitations of the standard formulary. If the drug is deemed medically necessary and there are no suitable alternatives on the formulary, the plan may approve the request, allowing Mr. Zachow to obtain the medication at a reduced cost rather than paying out of pocket.

This process is part of the protections put in place by Medicare to ensure beneficiaries have access to the medications they need, thereby promoting better health outcomes and adherence to treatment regimens. It is essential for individuals to know this right, as it empowers them to navigate their medication options effectively within the limitations of their insurance plan.