Why are there rules about whether and when certain drugs are covered?

Plans have rules that need to be followed before certain prescriptions can be filled. For instance, some drugs may have more side effects or have restrictions on how long they can be taken. Some drugs cost more than others even though some less expensive drugs may work for you just as well. All plans have an Exceptions process. If your doctor believes you need a drug that isn't on the plan's list or the plan has rules that should be waived, he or she can request an exception. Not all exceptions are granted. See Can I appeal my Medicare Prescription Drug Plan's decisions? for more information. Specific formulary information isn't included in this handbook because each plan has its own formulary. Formularies can change. Contact your plan for its most current formulary. All Medicare drug plans have negotiated to get lower prices for the drugs they cover. This means using drugs on your plan's list will generally save you money. You will get lower prices for your prescriptions before you meet the Deductible and when you are in the coverage gap (the period where you pay all of your costs). Using generic drugs can also save you money. For more information about other drugs you can use, go to www.medicare.gov on the web. Select "Compare Medicare Prescription Drug Plans." Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. (Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook 2007. This content may have been added upon by Q1Group LLC to include further examples, explanations, and links.)