2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 5: Using the plan’s coverage for Part D prescription drugs 155 receive your request (or your prescriber’s supporting statement). If we approve your request, we will authorize the coverage before the change takes effect. If you and your provider want to ask for an exception, Chapter 9, Section 6.4 tells you what to do. It explains the procedures and deadlines that have been set by Medicare to make sure your request is handled promptly and fairly. Section 5.3 What can you do if your drug is in a cost-sharing tier you think is too high? If your drug is in a cost-sharing tier you think is too high, here are things you can do: You can change to another drug If your drug is in a cost-sharing tier you think is too high, talk to your provider. There may be a different drug in a lower cost-sharing tier that might work just as well for you. Call Customer Service to ask for a list of covered drugs that treat the same medical condition. This list can help your provider to find a covered drug that might work for you. You can ask for an exception You and your provider can ask the plan to make an exception in the cost-sharing tier for the drug so that you pay less for it. If your provider says that you have medical reasons that justify asking us for an exception, your provider can help you request an exception to the rule. If you and your provider want to ask for an exception, Chapter 9, Section 6.4 tells what to do. It explains the procedures and deadlines that have been set by Medicare to make sure your request is handled promptly and fairly. Drugs in our Specialty Tier are not eligible for this type of exception. We do not lower the cost- sharing amount for drugs in this tier. Section 6 What if your coverage changes for one of your drugs? Section 6.1 The Drug List can change during the year Most of the changes in drug coverage happen at the beginning of each plan year. However, during the year, the plan can make some changes to the Drug List. For example, the plan might: · Add or remove drugs from the Drug List. · Move a drug to a higher or lower cost-sharing tier. · Add or remove a restriction on coverage for a drug. · Replace a brand name drug with a generic version of the drug. We must follow Medicare requirements before we change the plan’s Drug List. Section 6.2 What happens if coverage changes for a drug you are taking? Information on changes to drug coverage