Rytary Medicare Insurance Coverage
 

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?

Rytary/Medicare
 

In looking at the Medicare website, I have not seen any company yet put the drug on the Formulary. My understanding is that drugs can be added to the formulary at any time but since this is a new drug, the companies have not yet processed them. My drug company said that if the doctor would submit a pre-authorization, the price should be 40-50% less. We have been getting samples from the doctor so have not done this yet but it will be interesting to see. The quote I got from CVS for 360 95s was $840 per month!!!!

Rytary Medicare Insurance
 

The retail price you mention sounds similar to what I was quoted.