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Medicare drug plans: Restrictions on access to formulary drugs

News accounts have reported that some Medicare beneficiaries have encountered hidden restrictions when they try to obtain prescription drugs through the new Medicare drug plans. Even when a drug is listed as available through a plan formulary, unexpected barriers — such as “prior authorization” requirements, “step therapy” requirements, and “volume limits” — have been used by the sponsors of drug plans to delay or deny access. The use of these restrictive tactics means that even if seniors have carefully researched a Medicare drug plan, they can still encounter obstacles in obtaining medications.

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