Trying to cover an Rx that is non-formulary with my primary Medicare but formulary with my secondary Medi-cal?

Hi all,

My primary health insurance is Medicare (A & B), with a Part D pharmacy benefits plan thru Wellcare Classic PDP. My secondary insurance is Medicaid/Medi-cal (thru Community Health Group). I also qualify for and receive "Medi-gap" assistance from Medicare. I reside in California (92110), am 36 years old, and my income is nothing (disabled and on $14K/yr of SSDI, which doesn't count as income).

I have been prescribed a pricey new medication, but Medicare doesn't cover it. Then I realized that my secondary insurance's prescription drug formulary DOES include the medication I need.

My question is: if my primary Medicare Part D plan doesn't cover the drug, but my secondary insurance thru Medi-cal supposedly does, is it possible to get the drug approved & paid for?

Thank you in advance to someone who can answer; I can give more details if needed, just ask please.

submitted by /u/calijamesg
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