MHI – Q: Can my Part D plan remove drugs from their formulary during the year?

Posted by MedEd at MHI

A: Part D plans are allowed to remove drugs from their formulary during the year. Removing a drug from the formulary, increasing it to a higher cost sharing tier or adding a restriction like prior authorization, step therapy or quantity limits are all known as negative formulary changes.

The plan must provide a 60-day written notice to anyone on their plan who takes the medication and make a 60-day supply available to you. However, if the Food and Drug Administration decides that a medication is unsafe, it will be removed from the formulary immediately.


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