How do MA/Part D plans handle formulary changes?

• A. Formulary never changes after year start.
• B. Plans may update formulary during the year with notice and must notify enrollees; prior authorizations and exceptions may be required for new or removed drugs.
• C. Plans can remove drugs without notice and without any exceptions.
• D. Formulary updates require all enrollees to switch plans.

Answer: (B)

Formulary changes are a normal part of MA and Part D plans as they review medicines for safety, effectiveness, and cost. Plans can update the list of covered drugs during the year, but they must notify enrollees about which drugs are affected and when the change takes effect. If a drug is added or removed, the plan may require prior authorization or use an exceptions process to determine coverage. Enrollees (usually with help from their prescriber) can request an exception for a non-formulary drug or for coverage under updated rules, and the plan will evaluate that request. This approach lets plans stay current while providing a clear path to maintain access to needed medications through notice and the option for exceptions or authorization.