Is Your Medicare Plan Changing Coverage for Your Thyroid Medication?

Aug 26

3 min read

If you take Synthroid, levothyroxine, or another thyroid medication, you may receive a notice from your Medicare drug plan saying that something about your prescription coverage is changing.

Before you panic, here's the most important thing to know:

Medicare has not stopped covering thyroid medications.

Instead, your individual Medicare Part D or Medicare Advantage plan may be changing how it covers your particular medication.

Why Would My Coverage Change?

Medicare prescription drug plans have a list of covered medications called a formulary.

That formulary can change from year to year. Your medication could:

Move to a different drug tier
Have a higher copay or coinsurance
Require prior authorization
Require step therapy
Have a quantity limit
Be removed from the formulary
Be replaced by a preferred generic or alternative medication

For example, a plan might decide to favor generic levothyroxine instead of brand-name Synthroid.

That is an insurance coverage decision, not a medical recommendation.

Don't Change Your Thyroid Medication Just Because Your Insurance Changed

This is important.

If you've been stable on the same thyroid medication for years, don't stop taking it or switch medications solely because you received a letter from your insurance company.

Talk with your doctor first.

Your doctor can determine whether the alternative offered by your insurance company is appropriate for you or whether there is a medical reason you should remain on your current medication.

You May Be Able to Request an Exception

If your plan doesn't cover the medication your doctor believes you need, you aren't necessarily out of options.

You or your doctor may be able to request a formulary exception asking the insurance company to cover your medication.

Your doctor will generally need to explain why the covered alternatives aren't appropriate for you.

If the request is denied, Medicare drug plans also have an appeals process.

Ask About a Transition Fill

Another Medicare protection many people don't know about is the transition fill.

Under certain circumstances, when you enter a new Medicare drug plan or your plan changes coverage of a medication you've already been taking, you may be eligible for a temporary supply of the medication.

This isn't permanent coverage. Instead, it gives you time to work with your doctor and insurance company to determine what to do next.

This Is Why We Review Medicare Drug Plans Every Year

Here's the bigger lesson:

Just because your Medicare drug plan worked well this year doesn't mean it will be the best plan for you next year.

Every year, things can change:

Your prescriptions
Drug formularies
Drug tiers
Copays and coinsurance
Prior authorization requirements
Preferred pharmacies
Plan premiums

That's why I encourage my clients to review their prescription drug coverage during Medicare's Annual Enrollment Period, October 15 through December 7.

And don't choose a plan based on the monthly premium alone.

A plan with a very inexpensive premium can become an expensive plan if it doesn't cover the medications you actually take.

Received a Letter About Your Medication?

Don't ignore it, but don't panic either.

Find out exactly what is changing, talk with your doctor before changing your medication, and review your Medicare coverage to see what options are available.

That's exactly why having someone who understands Medicare in your corner can make such a difference.

Have Medicare questions?

Medicare Melanie is here to help.

Schedule your free appointment with Medicare Melanie today by calling

(904) 582 - 8067