If your doctor prescribes a drug that isn’t on your plan’s formulary or that’s in a high (expensive) tier, you should discuss this with your doctor. It’s possible that a different drug could be substituted and would result in lower out-of-pocket costs at the pharmacy. But if your doctor believes there are no substitutes that would work for you, it’s possible to request a formulary or tier exception. The Part D plan may or may not honor the exception request, but they will consider it.
If the exception request is denied, keep in mind that you have an opportunity to switch to a different Part D plan at least once per year, and possibly more often than that. The annual open enrollment period (October 15 to December 7) applies to everyone with any type of Part D coverage. There’s also a Medicare Advantage Open Enrollment Period (January 1 to March 31) that allows people with Medicare Advantage to make a plan change. And beneficiaries who qualify for Medicare’s Extra Help (income and asset-based eligibility) can make a change to their Part D coverage as often as once per quarter.