Understand quantity limits

KNIGHT RIDDER NEWSPAPERS
Q. My sister is on Medicare and signed up for a Medicare drug plan. For one of her medications, she takes three pills per day. When I checked it out on Medicare.gov, I noticed that the plan will only cover 30 pills per month -- even though her doctor told her to take more than that. What should we do?
A. Through the end of March, your sister should be able to receive the quantity she requires daily -- even if her Medicare drug plan only covers 30 pills per month. This is because the government requires plans to allow people to continue with their medications, as prescribed by their doctor, for a short period of time after they first enroll. However, because this policy is time-limited, your sister may not be able to get coverage for three pills per day after the transitional period ends.
Many of the Medicare drug plans limit the quantity of certain medications they cover each month. You may want to contact your sister's Medicare drug plan to be sure you understand how the quantity limits apply to her medication. Ask if the information on the Web site is correct. Then, ask if the plan would cover a 30-day supply if it entails taking three pills per day.
If the plan confirms the quantity limit of one pill per day, your sister can request an exception from her Medicare drug plan. She should find out what steps she and her doctor will have to take to apply for an exception. Most likely, she will need her doctor to fill out a form provided by her Medicare drug plan that explains why she needs to take the drug more than once a day.
Another option would be to switch to a different Medicare drug plan that covers her prescriptions without quantity limits, but she can only do this once before May 15.
It is important to start this process before the transition period ends at the end of March, so your sister does not have to cut back on her medications.
This column was prepared by the Kaiser Family Foundation, an independent, nonprofit private foundation based in Menlo Park, Calif., not affiliated with the Kaiser Permanente health plan. Send questions about the new Medicare drug benefit to Medicare Q & amp; A, The Kaiser Family Foundation, 1330 G St., N.W., Washington, DC 20005 or MedicareQ@kff.org.