What are "non-formulary" drugs in Medicare Part D?

Non-formulary drugs in Medicare Part D refer specifically to drugs that are not included in a plan’s coverage list. Each Medicare Part D plan has a formulary, which is a list of covered medications that are available to beneficiaries. When a drug is designated as non-formulary, it means that the plan does not provide coverage for that particular drug, which can significantly impact the cost and accessibility of medications for beneficiaries who need them.

Being aware of which drugs are non-formulary is crucial for beneficiaries, as it highlights the importance of reviewing a plan's formulary to understand which medications they will have access to and at what cost. Non-formulary status may also require beneficiaries to seek alternatives or go through a prior authorization process to obtain coverage, further emphasizing the need for clarity on what is or isn’t covered under their specific Medicare plan.