Blog
Prior authorization explained without the jargon: how Medicare Part D drug coverage decisions actually get made, what changes in the rules mean for you, and how the tools payers use stack up.
Academy
How-to guides, deep dives and definitive explainers
The Prior Authorization Form: Which One You Need
Which prior authorization form do you need for a Medicare Part D drug? The plan’s form, the CMS model form, and a worked example of the decision deadline.
Does Medicare Cover Mounjaro? The 2026 Answer by Use
Does Medicare cover Mounjaro? Usually yes for type 2 diabetes under Part D, subject to plan rules. Not for weight loss alone.
Does Medicare Cover Ozempic? The Honest Answer
Does Medicare cover Ozempic? Yes for type 2 diabetes, subject to plan-specific prior authorization — almost never for weight loss alone under Part D.
Medicare Part D Drug Tiers Explained: A Tier-by-Tier Guide
Medicare drug tiers explained: what tiers 1-5 cover, how cost-sharing and prior authorization change by tier, and how to request a tier exception.
Prior Authorization Denied? What to Do Next
Prior authorization denied for your Medicare Part D drug? Here's the appeal ladder, the deadlines, and why appealing is usually worth it.
Step Therapy Explained: What It Means and What to Do Next
What is step therapy? A practical guide to how it works in Medicare Part D, what your prescriber must submit, and how to avoid common mistakes.
How to Request a Formulary Exception: A Step-by-Step Guide
How to request a Medicare Part D formulary or tier exception: the steps, the deadlines, what your prescriber must write, and how long approval lasts.
The Prior Authorization Process, Step by Step
The Medicare Part D prior authorization process, step by step: exact deadlines, what a denial means, and how to appeal before the 60-day window shuts.
What Is a Formulary? The Complete Medicare Part D Guide
What is a formulary? A guide to how Medicare Part D drug lists are built, what tiers and restrictions mean, and how to find your plan's version.
What Is Prior Authorization? A Plain-English Guide
What is prior authorization? A plain-English guide to how it works for Medicare Part D, the deadlines involved, and what happens if you're refused.
How Long Does Prior Authorization Take?
How long does prior authorization take? Medicare Part D sets 72-hour and 24-hour deadlines, but real-world data shows why the wait is often longer.
News
Timely analysis of rule changes and industry moves
CMS's Electronic Prior Authorization Rule, Explained
CMS has proposed electronic prior authorization for drugs, but the rule isn't final. Here's the real status, the verified dates, and what's already law.
Does Medicare Cover Wegovy? The 2026 Answer
Does Medicare cover Wegovy? The accurate 2026 answer: the statutory exclusion, the stalled 2024 rule, and the cardiovascular carve-out that does work.
Reviews
Evaluations of the tools payers and pharmacies use
Looking for a specific payer or drug instead? Browse payers or browse drugs.