My Medicare Part D insurance company, Cygna, has designated Rytary as a tier 4 drug. Since this is the only drug that has worked for me, I requested a tier reduction. They denied my request, saying that Medicare rules prohibit them from offering a tier reduction for a drug that was not on their formulary.

Their formulary was published before the drug was approved for sale, so there was not a decision on their part to exclude it from coverage. It was just the result of the timing of the FDA approval.

Does anyone have any experience on how to get a tier reduction approved in a situation like this?